Australian mental health nurses’ workplace resilience and emotional labour: A mixed methods study

Background: Mental health nurses regularly engage in emotional labour, a form of workplace adversity, which requires them to self-regulate their emotions, emotional expression, and behaviour. Without adequate support, this labour can result in mental health nurses experiencing biopsychosocial ill-health and affect their capacity to be therapeutic. Workplace resilience, a process of positive adaptation to adversity such as this, can help mitigate these negative effects. There is limited evidence on mental health nurses’ workplace resilience, and no prior evidence on workplace resilience in the context of emotional labour, or the relationship between them.

Aim and Objectives: The overall aim of this explanatory sequential mixed methods research was to investigate the workplace resilience of Australian mental health nurses and explore how they positively adapt and maintain their resilience in the face of emotional labour at work. Objectives were to:
1. Identify mental health nurses’ levels of workplace resilience, emotional labour, mental distress, and psychological well-being.
2. Determine the relationship between mental health nurses’ levels of workplace resilience, emotional labour, mental distress, and psychological well-being.
3. Explore mental health nurses’ experience of workplace resilience and emotional labour to gain an understanding of how mental health nurses build and maintain their resilience in the face of emotional labour.
4. Explore how the qualitative findings help explain how mental health nurses maintain their workplace resilience in the context of high emotional labour.

Methods: The research was conducted in three phases. Phase 1 involved a cross-sectional survey of n=482 Australian mental health nurses. Participant characteristics, workplace resilience, emotional labour, mental distress, and psychological well-being were collected and analysed. Analyses included description, correlation, and regression models. Phase 2 involved purposeful selection of n=11 participants scoring higher in workplace resilience and emotional labour, who participated in semi-structured telephone interviews. An interpretive qualitative design and reflexive thematic analysis was used to analyse interview data. In Phase 3, quantitative and qualitative findings were integrated, and meta-inferences produced to explain how workplace resilience was maintained in the context of high emotional labour.

Findings: In Phase 1, more than half (n=258, 53.52%) of participants had high levels of workplace resilience (M=70.27 [possible maximum 100]). This was associated with higher psychological well-being and lower emotional labour and mental distress. Participants receiving clinical supervision had higher workplace resilience.
Four themes were derived from Phase 2 qualitative analysis. Three related to how participants built and maintained their workplace resilience: Being attuned to self and others, Having a positive mindset grounded in purpose, and Maintaining psychological equilibrium through proactive self-care. The fourth related to factors that impeded their workplace resilience: Running on emotionally empty.
Three meta-inferences resulted from integration: (1) Higher workplace resilience involves a growth mindset and proactive use of available clinical supervision, (2) Higher workplace resilience involves drawing on emotional intelligence capabilities, and (3) Higher workplace resilience involves humanistic values and a sense of purpose in the mental health nursing role.

Conclusion: Mental health nurses' emotional and mental equilibrium impacts their capacity to maintain their resilience and positively adapt to the emotional labour of their work. To support their practice, key recommendations include health services proactively providing, and supporting mental health nurses to engage in professional and personal development opportunities to strengthen their mental and emotional well-being and workplace resilience. This will strengthen their practice and help mitigate negative effects of emotional labour.

© Cynthia Delgado, 2024.