Making sense of violence and victimization in health care work: The emotional labour of ‘not taking it personally’
| Published date | 01 January 2021 |
| Author | Rachel Herron,Laura Funk,Dale Spencer |
| DOI | 10.1177/0269758020953760 |
| Date | 01 January 2021 |
| Subject Matter | Articles |
Article
Making sense of violence and
victimization in health care
work: The emotional labour
of ‘not taking it personally’
Laura Funk
University of Manitoba, Canada
Dale Spencer
Carleton University, Canada
Rachel Herron
Brandon University, Canada
Abstract
Despite significant impacts on employee health, workplace violence tends to be minimized and
normalized by service workers and by organizations, with employees implicitly held culpable for
causing aggression through how they manage interactions. Little is known about how workers
accomplish minimization and normalization, or how this process might be entwined with the
emotional labour of containing difficult emotions. In this paper an emotional labour lens is joined
with a social phenomenological approach to analyze in-depth interviews with 26 employees of one
multi-unit health care facility in Western Canada. The purpose was to examine health care
workers’ emotional and interpretive responses to aggression from patients and families. Through
undertaking ‘deep acting’ and maintaining their moral identities, workers contained fear through
minimizing and normalizing aggression and contained frustration through acknowledging mitigating
circumstances. This involved constructing themselves as victims of misdirected emotions, and
patients and families as victims of aging, caregiving, disability, dementia, and/or dying processes.
Emotional labour supports organizational interests in ensuring smooth workflows and promoting
patient satisfaction and well-being. It involves ambivalence and contradiction and can reproduce
discourses detrimental both to workers and to resident care.
Corresponding author:
Professor Laura Funk, Department of Sociology and Criminology, University of Manitoba. 307–183 Dafoe Road, Isbister
Building, Winnipeg, Manitoba, R3T 2N2, Canada.
Email: Laura.Funk@umanitoba.ca
International Review of Victimology
2021, Vol. 27(1) 94–110
ªThe Author(s) 2020
Article reuse guidelines:
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DOI: 10.1177/0269758020953760
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Keywords
Canada, emotional labour, interpretive methodology, residential care work, workplace violence
Existing international scholarship has identified workplace violence as an issue in a wide variety of
occupational fields, such as call centre work (Grandey et al., 2004), employment centres (Bishop
et al., 2005), security and policing (Button and Park, 2009; Martin, 1999; Schaible and Gecas,
2010), and airline/railway industries (Boyd, 2002). Workers in health care settings are particularly
at risk (Standing Committee on Health, 2019), including nurses and ambulance staff (Crilly et al.,
2004; di Martino 2002; Gacki-Smith et al., 2009), hospice workers (Gunaratnam, 2001) and care
aides (Geiger-Brown et al., 2007; Kelly, 2017), who often disproportionately represent both
gendered and racialized populations. In Canada’s long-term care sector, violence against care
aides, including forms of racism and sexism, has been identified as a particular problem, and
connected to broader systemic and organizational forces in that secto r (Banerjee et al., 2012;
Braedley et al., 2018; Brophy et al., 2019).
Above and beyond the difficult emotions and stress arising from violent encounters at work, the
process by which workers manage and regulate their emotions and emotional displays in these
moments can also be problematic, contributing to emotional dissonance, burnout, guilt, depression,
detachment, depersonalization and exhaustion (Geiger-Brown et al., 2007; Mann, 2005; Schaible
and Gecas, 2010). Indeed, ‘the worker can become estranged or alienated from an aspect of self
[...] that is used to do the work’ (Hochschild, 1983: 7).
In the last 30 years researchers have identified a drive by organizations to access, valorize and
actively manipulate employees’ emotional knowledge and skills, as a dimension of labour power
and often as an aspect of ‘customer service’ (Alvesson, 2004; Korczynski, 2003; Van Dijk et al.,
2011; Warhurst and Nickson, 2007). Frontline employees may be required to ‘induce or suppress
feeling in order to sustain the outward countenance that produces the proper state of mind in others’
(Hochschild, 1983: 7). These expectations may be intensifying as corporations seek competitive
gain through promoting the adage, ‘the customer is always right’ (Boyd, 2002; Grandey et al.,
2004; Yagil, 2008). In situations where clients act aggressively towards workers, this can render
workers relatively powerless, and exacerbate structured inequities.
The objective of this article is to apply the concept of emotional labour (Hochschild, 1983) to
explore how aggressive acts by patients or their family members are interpreted by nurses and care
aides in a residential health care setting. Emotional labour illuminates how organizati ons can
produce vulnerabilities in workers by requiring them to suppress their emotional responses to
verbal and physical abuse in interactions with clients or customers (Johnson, 2015). This concept
can enhance our understanding of how and why workers respond in particular ways to experiences
of violence or aggression. Hochschild (1979, 1983) explains how organizationally prescribed
norms about appropriate emotions and their display contribute to self-presentation processes such
as surface acting (i.e. regulating emotional display or expression), or deep acting (i.e. modifying
emotions themselves). The latter entails, for instance, control of physiological reactions as well as
invoking thoughts and ideas associated with specific emotions so as to gen erate the required
feelings (Ashforth and Humphrey, 1993; Bhowmick and Mulla, 2016; Thoits, 1990).
Some emotional labour literature psychologizes these processes as a form of emotion-focused
coping in response to stressful situati ons (Grandey et al., 2004; Yagil, 2008), obscuring how
emotion regulation is structurally shaped, commodified and intensified (in training, by manage-
ment, in organizational discourse and policy), and how organizational conditions contribute to the
Funk et al. 95
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