On Nurses and Emotional Labor

My last post described how doctors appear to rely on a specific feeling norm in managing and displaying emotional states in relation to their patients. The pattern I saw in my own care was initial emotional distance from doctors that gave way to greater emotional availability only when my prognosis significantly improved. In this post, I offer some speculations about the differences between doctors and nurses when it comes to emotional labor.

Whereas doctors may be permitted an initial clinical detachment from their patients, nurses are socialized to be more explicitly caring in their interactions with patients. This distinction between the emotional distance of doctors and emotional availability of nurses is furthered reinforced by the gender division of labor that leads to male predominance among doctors and female predominance among nurses.

For all these reasons, nurses face even bigger challenges than doctors in managing emotional involvement with patients. This difference in role expectations is reinforced by the daily reality that nurses typically spend much more time with patients across a broader range of interactions than doctors typically do.

The upshot is that whereas my doctors only became emotionally accessible late in the game, most of my nurses were friendly, nurturing and emotionally supportive from the beginning of my treatment and without regard for my prospects of survival. While this is beneficial for patients, it can be challenging for nurses when patients they have come to care about do not respond to life-saving treatments.

In extreme cases, this may lead to the suicidal behavior reported in an earlier post on this site. But even absent such tragic outcomes, the challenge of managing emotional states looms large for nurses in general and some in particular.

As a final case in point, I recall a conversation about one of my nurses I’ll call Kelly. Even compared to other nurses, Kelly was unusually warm, nurturing and supportive throughout my extended care. She became my “favorite” precisely because of the emotionally rich bond we formed right from the beginning.

It was only when I mentioned this to another nurse that I learned of the downside of Kelly’s demeanor. I was told that when Kelly’s patients did not survive, she was emotionally devastated and took a long time to psychologically recover. Because my treatment went well, I did not witness this challenge. But it stands to reason that while such emotional availability can be rewarding for both nurse and patient, it is also extremely stressful for nurses when their patients do not recover from their illness.

It may be that the most profound challenges of nursing lie not in technical mastery of clinical procedures, but in crafting a “feeling norm” that balances caring for others while also caring for self.