ABSTRACT
This study introduces perceived organizational support (POS) as a moderating variable to provide some explanations to the possible relationship between emotional labour, emotional intelligence and job attitudes among nurses and midwives in Ghana. The study employed a sequential explanatory mixed-method approach (QUAN-qual), a cross-sectional design and proportionately sampled three hundred and forty-two (342) nurses and midwives from six public and quasi-public health facilities in the Greater Accra Region of Ghana. With use of standardized survey questionnaires and an interview guide, findings from the quantitative study (using SEM) revealed that while surface acting and emotional intelligence significantly predicted job attitudes, deep acting failed to show any significant association with job attitudes. It was further discovered that POS significantly moderated the relationship between deep acting and emotional intelligence on one hand and job attitudes on the other hand. However, POS did not moderate the relationship between surface acting and job attitudes. Findings from the qualitative study (using thematic analysis) provided insight to the relationship or no relationship between the study. In addition, religio-social resources encompassing religion/spirituality and social support were identified as additional job resources in helping health professionals to handle the emotional demands of their profession. The theoretical as well as the practical implications of the study findings were extensively discussed in relation human resource practice, academia and professional healthcare delivery.
CHAPTER ONE
INTRODUCTION
Background of the Study
The pivotal role of emotions at work is not anything new even though the phenomenon has not been an explicit one in the extant literature of organisational behaviour. (Ashforth & Humphery, 1993; Choi & Kim, 2015; Dartey-Baah & Mekpor, 2017). Thus, the interest in emotions-related issues has a long history, yet the field only began to emerge as an autonomous arena of systematic study during the latter part of 1900s (Dartey-Baah & Mekpor, 2017; Goleman, 2005; Goleman, 2007). Employees in their world of work encounter diverse work demands which have consequences on the emotions as well as their behaviours (Dartey-Baah & Mekpor, 2017). It is worth stating that emotional expressions of employees as a result of their work demands require them to mostly control their feelings in order to meet the requirements of the job (Zapf, 2002; Jung & Yoon, 2014). It also implies employees need to be much skillful in managing their own emotions as well as managing the emotions of others (Dartey-Baah & Mekpor, 2017). Topical issues under emotions at work in contemporary times hover around emotional labor (Hochschild, 1983, Mróz & Kaleta, 2016) and emotional intelligence (Dartey-Baah & Mekpor, 2017; Ghoreishi et al., 2014). Contemporary emotion-related theory (see Grandey, 2000; Grandey, 2003) and empirical work (see Diefendorff & Richard, 2003; Pugh, 2001) advocate that the display of appropriate emotions and emotional management are important for success in numerous jobs. The strategic role of emotions’ management has made it an imperative dimension in employee work performance with a view to ensure regulation and management of employees’
behaviour and emotional expression to achieve service excellence, employees’ satisfaction, and profitability (Mans, Schonenberg, Song, Aalst, & Bakker, 2008; Steinberg & Figart, 1999). The quality of service provided always gives organisations an urge ahead of the competing industries. For service industry practitioners, such as sales staff, nurses, midwives, teachers, flight attendants and police officers, emotional labour and emotional intelligence are integral parts of their work (Dursun, Bayram & Aytaç, 2011).
Emotional Labour and Job Attitudes
The idea of emotional labour was initially coined by Hochschild (1983). As argued by Hochschild (1983), emotional labour as a concept refers to the management of emotional state to generate an open and apparent facial and bodily display to keep up with job requirements. Hochschild further argued that emotional labour is exchanged for a pay and hence, has ‘exchange value’. Since the introduction of emotional labour, the concept has become a contemporary subject matter among researchers and practitioners within the fields of psychology and management (Ashforth & Tomiuk, 2000; Grandey, 2000; Grandey, Tam, & Brauburger, 2002; Zapf, 2002).
In the words of Grandey (2003) and Hennig-Thurau, Groth, Paul & Gremler (2006), the conceptualisations of emotional labour suggests that employees in an attempt to display emotions that are deemed appropriate at work occasionally must fake or hide their felt emotions (surface acting) or must attempt to experience the desired emotions (deep acting). This happens due to the fact that most jobs do have the anticipation that employees are to exhibit positive emotions. While deep acting typically comprises of employees trying to experience the positive sentiments so that
anticipated positive emotions also follow, surface acting typically encompasses falsifying positive
emotions or even sometimes suppressing one’s negative felt emotions so that positive emotions follow (Grandey, 2003; Hennig-Thurau, Groth, Paul, & Gremler, 2006).
On this basis, these two emotional labour approaches (deep acting and surface acting) have been described as “acting in good faith” and “acting in bad faith” respectively (Grandey, 2003; Hennig-Thurau, Groth, Paul, & Gremler, 2006; Hochschild, 2012). While the former involves attempting to experience the emotions, the latter encompasses going through the emotions (Grandey, 2003; Hennig-Thurau, Groth, Paul, & Gremler, 2006; Hochschild, 2012). On the contrary, other existing argument points that employees can engage in appropriate emotions without necessarily engaging in only deep acting (DA) and surface acting (SA) (Ashforth & Humphrey, 1993; Brotheridge, 2006). Nevertheless, SA and DA may be considered compensatory strategies that help individuals express emotions that do not come naturally (Hennig-Thurau, Groth, Paul, & Gremler, 2006; Hochschild, 2012).
It therefore implies that employees can control their emotions to reflect their work role demands through dual key approaches (surface acting and deep acting). In surface acting, employees always make customers see their mandated emotional expressions, even when employees feel differently (Grandey, 2000). For example, employees in an attempt to handle troublesome customers may counterfeit a smile even when in a bad mood. Deep acting involves taking charge of intrinsic thoughts and feelings in order to meet the expressive strains of work (Brotheridge, 2006b).
In one of her books “The Managed Heart”, Hochschild (1983; 2012) elucidated that there
are three main characteristics of jobs which will demand emotional laboring: (a) when the job
demands a face-to-face or phone contact with the public or clients, (b) when the job requires workers to generate an expressive state in an alternative person, and (c) when per the nature of the job, the employer has control over the expressive actions of workers.
According to Hochschild (2012) and Wharton & Erickson (1993), such employees are identified as boundary spanners and designated that these employees are most likely to come across emotional labor as a central part of their work duties. To these researchers, boundary spanners are those workers who by virtue of their positions and responsibilities provide a direct link between their organisations and people they interact with (external to the organisation). This implies that these interaction frontiers have the tendency of carrying on the organisational brand of delivery by engaging in emotional labour.
Some empirical studies have been found to link emotional labour to work attitudes including the extent to which employees are committed to their organsiation (organizational commitment) and their level of satisfaction on the job (job satisfaction) (Brotheridge & Lee, 2003; Ghalandar, Ghorbani, Jogh, Imani & Nia, 2012; Hur, Han, Yoo & Moon, 2015). The existing studies are pointing to the fact that emotional labour has some significant associations with specific work attitudes. (Brotheridge & Lee, 2003; Hur, Han, Yoo & Moon, 2015). These associations have mostly been identified to be negative despite inconclusive result (Choi & Kim, 2015). Conversely, emotional regulation has been found to have both positive and negative impact on organisational commitment (Ghalandar, et. al., 2012). Hochschild (1983) has earlier opined that inauthentic surface acting over time results in a feeling detachment from one’s true feelings
and from others’ feelings. In line with this, Grandey (2003) re-emphasised that when employees
engage in surface acting, this in effect has negative impact on employees’ work attitudes including commitment to their organisations as well as satisfaction on their jobs. Conversely, when employees embrace deep acting in their works, they show genuine feelings which consequently make them have positive attitudes towards work (Grandey, 2003). Stated differently, employees’ performance of emotional labour changes their attitudes towards work (Wong & Law, 2002)
Emotional Intelligence and Job Attitudes
On the other hand, emotional intelligence is pointed to be a key psychological capital/personal resource for employees in the service sector (Mensah & Amponsah-Tawiah, 2014) with no exemption to employees in the health sector specifically nurses and midwives (Brink, Van der Walt, & Van Rensburg, 2006; Brink, Van der Walt, & Van Rensburg, 2012; McQueen, 2004). The concept was firstly introduced into the scientific literature through the works of Salovey and Mayer (1990) even though it has a long history (Gayathri & Meenaksi, 2013). Salovey and Mayer (1990) conceptualised emotional intelligence as an “ability to monitor one’s own and others’ feelings and emotions, to discriminate among them and use one’s thinking and action” (p.189). Emotional intelligence can also be labelled as a range of capabilities which mirror the extent to which individuals effectively deal with emotion both within themselves and others; it consists of one’s perception, understanding and management of self-emotions and those of others (Bradberry & Greaves, 2009; Goleman, 2005; Mayer, Salovey & Caruso, 2008). Researchers on emotional intelligence have provided a clear evidence on how emotional intelligence differs from other kinds of intelligence such as intelligence quotient (IQ). To them, emotional intelligence entails a set of
skills which enable an individual in regulating own and others’ emotions (Gayathri & Meenaksi, 2013).
Emotional intelligence from the viewpoint of Salovey and Mayer (1990) is seen as a cognitive ability which can be logically analysed. However, other researchers to the construct conceptualizes the phenomenon as a trait (Petrides, & Furnham, 2003) and mixed ability including personality as well as cognitive ability (Gayathri & Meenaksi, 2013). These perspectives have led to what is now acknowledged as “ability model”, trait model and the “mixed ability models” (Gayathri & Meenaksi, 2013).
Forerunners of emotional intelligence provide diverse classifications and dimensions to the construct. For instance, while Mayer and Salovey (1990) emphasise on four facets to emotional intelligence including emotional perception, emotional assimilation, understanding and management, Bar-On (2002) places emphasis on emotional self-awareness, self-actualisation, reality resting, interpersonal relationship, stress tolerance, happiness, optimism and among others and Goleman (1998; 2005; 2014) points out to dimensions including emotional self-awareness, self-control, empathy, problem solving, conflict management, leadership and among others as the constituents of emotional intelligence (cited in Gayathri & Meenaksi, 2013).
Employees who are have the ability and trait of understanding and managing their emotions and those of others have the tendency of exhibiting positive work attitudes such as job commitment, satisfaction on the job, be more engaged to work, more willing to engage in voluntary work activities (Carmeli, 2003; Rankin, 2013; Trivellas, Gerogiannis & Svarna, 2013; Rahmati &
Mohebi, 2016). Similarly, these workers are less likely to engage in negative work activities including turnover intentions and counterproductive behaviours (Trivellas, Gerogiannis & Svarna, 2013). This is more instrumental in specific sectors like the health sector including nurses and midwives (Brink, et. al., 2006; Brink, et. al., 2012; Smith et. al. ,2009; Stayt, 2009) as emotional regulation and emotional management is core responsibility of nurses and midwives.
Health Professionals, Emotional Regulation and Emotional Management
One must acknowledge that traditional nursing and midwifery were organized in such a way that health professionals were encouraged to obscure their emotional attachment to patients in order to maintain a professional fence (Brink, et. al., 2006; Brink, et. al., 2012; McQueen, 2004; Menzies, 1960). This is a way helped these health professionals to protect themselves from the emotional involvement and concerns of patients in order to pay more attention on the physical care of patients. However, in contemporary times, there is a shift from the distance approach of handling patients to a more involved and committed approach (McQueen, 2004; Williams, 2000) and has therefore yielded a less formal relationship between nurses, midwives and patients. Health professionals do now place much emphasis on concepts such as open communication, partnerships, good rapport, mutual understanding, intimacy, just to mention a few (McQueen, 2000; McQueen, 2004; Theodosius, 2008). Professionals are encouraged to adopt a holistic approach to handling patients and thereby employing social, spiritual, physical and psychological
dimensions to their professional care in order to facilitate the needs of patients (McQueen, 2004; Theodosius, 2008) and also attain positive job attitudes (Luker, Austin, Caress & Hallett, 2000).
The significant and competitive nature of the health sector in most parts of the world has called for devising new approaches in attaining and sustaining competitive advantage by delivering high-quality service (Copperman, 2010; Shani, Uriely, Reichel & Ginsburg, 2014). This renders the importance of high-quality nurse and midwife professionals undisputed due to the fact that when this type of workforce is lacking or inadequate in health care organisations, these organisations fail to meet the demands of their customers (Tews, Stafford & Michel, 2014). It is worth stating that the nature of work in the health sector is not fully purely cognitive, intellectual, physical or sensory-motor but rather emotional regulation and emotional management are pivotal (Brink, 2012; McQueen, 2004; Zapf, 2002). That is to say, the work demands of health sector employees are not solely dedicated to physical, technical and intellectual demands but emotion management also play an instrumental role due to interactions with diverse patients/clients (Brink, 2012; Chu & Murrmann, 2006; Jung & Yoon, 2012). Health sector workers particularly, nurses and midwives who manage their emotions effectively enhance their organisation’s performance as well as enhance positive employees work attitudes and behaviours (Grandey et al., 2005; Härtel et al., 2008). This relationship between workplace emotions and job attitudes and behaviours are even further enhanced by specific organisational factors such as perceived organisational support (Gyekye & Salminen, 2009; Kim, Hur, Moon & Jun, 2017).
Overview of the Health Sector and Health Professionals in Ghana
In Ghana, the health sector is structured under three main hierarchies: national, regional and district. Various clinics and hospitals in the various districts and regions are structured to attend to the health needs of the populace at various levels. These are strongly in relation to the minimum benefit package and accreditation status of each facility on the basis of the conditions provided the under National Health Insurance law (Netherlands Enterprise Agency, 2015). The various health facilities at the district level within the country are incorporate community health delivery with the aid of the sub-district services. At the heart of the health is the prevention, promotion and curative services purposefully for health interventions. It is the mandate of the Ministry of Health to oversee the policy guarding the quality as well as equity of access to health services in the country specifically, in the public sector. The ministry is also responsible for managing the human resources of the sector. It is worth stating that the private sector in the health setting in recent times has expanded especially, in the urban centres. On the contrary, private health facilities are licensed and regulated by The Private Hospitals and Maternity Homes Board.
That is to say, the health sector in Ghana is in conversion from a principal government (public) health facilities towards a more varied and dispersed system. It is argued that the public health system is an extension from its socialist past, when government was the sole provider. It turns out to be progressively difficult to endure this system due to the limited available public funds. Subsequently, the appraisal and successive ramble of salaries of public sector workers in 2009, the government capitals for the public sector are excessively assigned to salaries (65-70%
of existing government expenditures). The monetary spaces for other recurring disbursements and capital investments are seriously constrained as a result. In order to relieve the pressure on the public health budget, the government encourages private sector initiatives to actively engage. Private health services balance the public sector. As the days of free health care in the public hospitals are over, the costs are becoming increasing less of a barrier. Private health facilities in the country are believed to have added value to the health facilities existing in the country in relation to quality and convenience. Thus, the private health facilities gaining more attention mainly due to the unique services they provide which are mostly not existence in the public facilities. The engagement of private health providers has grown to the extent that international organisations have permeated in the market.
