’I don’t have any emotions’: feeling rules and surface acting in the emergency department…

Miss Kate Kirk1

1University Of Nottingham, Nottingham, United Kingdom

It is undeniable that the challenges facing health services have implications for the staff tasked with delivering care. Low rates of well-being have a direct impact on the quality of care delivered (Boorman, 2009). Despite evidence showing the importance of positive nurse well-being, the emotional component of the role (a great influencer in well-being) (Warren, 2016; Johnson and Spector, 2007), is overlooked (Smith, 2012). An integral part of nursing is often neglected: the emotional labour of nursing.

I have applied Hochschild’s theory of emotional labour to a previously unexplored clinical speciality: emergency care. Emergency departments are struggling to meet demand in the UK, with increasing patient attendance over the last 70 years (The King’s Fund, 2018) and intense government targets (NHS England, 2018). In spite of these challenges, and the nature of EDs, an exploration of ED nurses’ emotional labour is missing from current understanding. We know little of how the ED environment influences the management of emotion or how nursing specialities, such as emergency care, drive the ‘speciality-specific’ feeling rules.

The ED therefore offered a fitting case study to explore emotional labour. Ethnography enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nursing team, allowing for the dynamism of the setting and pace. I used two departments for a rich and illuminating dataset.

I aimed to understand how the environmental, institutional and organisational dynamics of the ED instrumented the emotional labour. I found that elements of time and space were ‘moderators’ of ED nurses’ emotional labour. Secondly, I aimed to understand the feeling rules driving and underpinning this behaviour. I found that ED nurses’ feeling rules were grown from the distinctive context and that four feeling rules drove their emotional labour. The recommendations from this study relate to working environments and nursing education.


Kate is a registered nurse, qualifying in 2011 with a BSc (Hons) in Nursing from the University of Lincoln. After working clinically full-time in an emergency department and major trauma centre in the UK, she completed the ‘Bronze Scholar’ research internship award with Health Education East Midlands. This sparking a passion for healthcare research. The internship led to a place on the MA in Research Methods (Health Pathway), highly competitive and fully funded through the National Institute for Health Research. On completion, Kate began her PhD in Health Management at the University of Nottingham in 2015, joint funded by CLAHRC East Midlands and CHILL (Centre for Health Innovation, Leadership and Learning). The research explores Arlie Hochschild’s emotional labour theory in the emergency department setting. She is currently working as a research fellow on a national ‘Embedded’ research study, aiming to increase the influence of health service research on decisions about the improvement and redesign of the NHS. Her research interests focus on: emergency care; evidence into practice; implementation science; medical and nursing sociology; healthcare workforce; emotional labour; organisational behaviour in healthcare; qualitative research design, ethnographic methods and ethics.