the suppression of negative

The suppression of negativeemotions in elder care

Jennifer Z. GillespieDepartment of Psychology, University of South Florida Sarasota-Manatee,

Sarasota, Florida, USA

Patricia B. BargerKronos, Inc., Beaverton, Oregon, USA

Jennifer E. YugoSchool of Business Administration, Oakland University, Rochester,

Michigan, USA, and

Cheryl J. Conley and Lynn RitterAlzheimers Association, Northwest Ohio Chapter, Toledo, Ohio, USA

Abstract

Purpose The purpose of this paper is to describe two studies that investigate the suppression ofnegative emotions in the context of elder care, including the emotional job demands that may, togetherwith display rules, elicit negative suppression (Study 1) and the association between negativesuppression and job attitudes (Study 2).

Design/methodology/approach Group interviews were conducted to understand the emotionaldemands of elder care (Study 1), and a survey was administered to direct care providers that includedmeasures of negative suppression, job satisfaction, and job stress (Study 2).

Findings Difficult events with patients (e.g. deterioration) are an emotional demand that mayinteract with display rules to elicit negative suppression (Study 1). Negative suppression is generallyassociated with less favorable job attitudes, controlling for individual differences in affectivity(Study 2).

Research limitations/implications This investigation is the first both to qualitatively examinethe emotional demands of elder care (Study 1) and to empirically demonstrate links between negativesuppression and job attitudes (Study 2).

Practical implications Practitioners face difficulties with recruitment and retention in elder care;the results suggest that negative suppression is a possible point of intervention.

Social implications There is a shortage of direct care providers in the context of elder care, andthe results of the present investigation potentially suggest how to improve working conditions.

Originality/value The focus on negative suppression in the context of elder care is unique.

Keywords Emotional labor, Negative suppression, Employees attitudes, Job satisfaction, Elder care

Paper type Research paper

The current issue and full text archive of this journal is available at

www.emeraldinsight.com/0268-3946.htm

The majority of this research was conducted in the Department of Psychology at Bowling GreenState University. This research was supported in part by a National Institute for OccupationalHealth and Safety Pilot Research Project Grant (#T42/OH008432-01) from the University ofCincinnati Education and Research Center.

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Received May 2010Revised January 2011Accepted February 2011

Journal of Managerial PsychologyVol. 26 No. 7, 2011pp. 566-583q Emerald Group Publishing Limited0268-3946DOI 10.1108/02683941111164481

Long-term care for the elderly (i.e. elder care) is facing a serious supply-and-demandproblem in the USA. On the demand side, over three million Americans currently maketheir home in either an assisted living community or in a nursing facility, with threemillion more using home health services (American Health Care Association, 2010a).The number of Americans over the age of 65 is increasing steadily (Administration onAging, 2010), and by the year 2050 it is expected that 27 million Americans will useelder care. On the supply side, there is already a staffing shortage. The turnover ratesin assisted living currently range from 21 to 46 per cent, depending on the position(American Health Care Association, 2010b), whereas the turnover rate for all jobsnationwide is only about 3 per cent (Bureau of Labor Statistics, 2010).

Previous researchers have suggested more attention be paid to the emotional laborassociated with elder care (e.g. Wharton, 2009). Care work is defined as a form ofinteractive service that involves the maintenance and development of the capabilitiesof others (England, 1992, 2005), in which caregivers give sustained, close, direct mentaland physical attention to the persons being cared for ( James, 1992). Emotional laboroccurs when employees manage their feelings in accordance with organizationallydefined rules and guidelines (Hochschild, 1983; Wharton, 2009). There is a wealth ofresearch on emotional labor in prototypical customer service contexts, such as callcenters and restaurants (e.g. Barger and Grandey, 2006; Groth et al., 2009). Theseemployee-customer interactions are characterized by relatively brief customerinteraction and the provision of service with a smile. In contrast, elder carerelationships occur over longer periods of time (e.g. Gutek et al., 1999) and involvemanaging a variety of emotions, some of them contradictory (e.g. Bolton, 2000).

Psychological theories of emotional labor posit a stimulus-response model wherebypeople regulate or control an emotion that would be inappropriate to express in a givensocial situation (Grandey, 2000; Gross, 1998). In this way, employees exert effort to produceappropriate emotional displays in the face of emotional demands (e.g. difficult customers;Goldberg and Grandey, 2007). Especially when emotional labor involves working tosuppress or conceal negative emotions, termed negative suppression, it may have seriouspsychological and physical costs (e.g. Mauss and Gross, 2004). Thus, negative suppressionis important to study, as it has direct implications for employee health.

Based on the foregoing discussion, we present two studies conducted in elder careorganizations that address different parts of the emotional labor process (Grandey,2000). Study 1 uses group interviews to better understand the emotional demands ofelder care, which together with display rules are theorized to elicit the suppression ofnegative emotions. Study 2 uses survey methodology to examine the empiricalrelationship between negative suppression and job attitudes, which are theoreticaloutcomes of emotional labor. In the discussion, we explain the implications of thesestudies for improving human resource management in elder care.

Study 1In Study 1, we conducted group interviews to better understand the emotionaldemands of elder care from the perspective of the people who actually do the work. Thejob activity assisting and caring for others is high in emotional demands (Glombet al., 2004), yet we know relatively little about the events that comprise these ongoingdemands in the context of elder care. Thus, we wanted to better understand the kindsof affective events or shocks that elicit felt emotion, such as anger (Weiss and

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Cropanzano, 1996), which together with display rules may motivate employees to usenegative suppression (Grandey, 2000).

As mentioned, it is relatively common in the literature to study emotional labor inprototypical customer service jobs, where the display rules suggest that employeesprovide service with a smile (e.g. Barger and Grandey, 2006). In elder care, however,there are not only display rules but also implicit feeling rules or value systems(Fineman, 1993) that govern emotional displays. In general, the goal is to appear kindand caring, yet calm and detached and to not give in to ones own feelings (Bolton,2001; Carmack, 1997; Henderson, 2001). In this way, direct care providers may beemotional jugglers where they express a variety of emotions, some of themcontradictory (Bolton, 2001). Part of this juggling act stems from the consensus amongcaregivers that to a certain degree effective care work necessitates involvement withthe recipient of care. That is, for caregivers to remain too distanced would be lookingafter their own interests rather than those of their patients (Bolton, 2001, p. 91).

Focusing on the question of what are the emotional demands of elder care work,general psychological theory suggests that events appraised as a threat to well-beingelicit negative emotions; further, it suggests that people will make efforts to managethose emotions (Lazarus, 1975, 1999). Applied research shows that being treatedunfairly or with hostility by customers is associated with heightened efforts to regulateor manage emotions at work, as employees exert themselves to suppress or conceal theresulting negative emotions (Grandey et al., 2004; Rupp and Spencer, 2006; Spencer andRupp, 2009).

In the context of elder care, however, patient aggression is yet another possibleemotional demand. One reason for this aggression is that, unlike the prototypicalservice encounter, the customers in long-term care may have dementia, as it isexperienced by 60 per cent to 80 per cent of nursing home residents (Beers and Berkow,2005). Dementia is characterized as a loss of intellectual power (Bond, 1999), and itsbehavioral and psychiatric manifestations include aggression, wandering, anddelusions (Nagaratnam et al., 1988). Related, sometimes patients exhibit acts ofaggression toward the people who care for them (Gates et al., 2005).

Thus, in the present study, we expected based on existing research that theemotional demands of elder care may include being treated unfairly or with hostility byresidents and being subject to acts of physical aggression.

MethodParticipants and procedure. Twenty-eight employees of two elder care facilities(nursing home and assisted living) located in the Midwestern United Statesparticipated in one of four group interviews. Participants were asked, What are someexamples of situations in which your job as a caregiver has been demanding,cognitively and/or emotionally? We were interested to hear about events thatillustrate the demands of elder care; thus, we encouraged them to talk concretely aboutspecific incidents. The first author and/or a co-author with experience in elder carefacilitated the discussion while a co-author maintained a record of what was said.Study participants received a $25 gift card.

Coding of group interview data. Three co-authors and two graduate researchassistants independently coded all 91 statements for the dominant theme expressed,resulting in a kappa of 0.95 (Fleiss, 1971). The following four themes were accepted:

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(1) difficult events with patients;

(2) work/home conflict;

(3) patient-family stress; and

(4) money and job concerns.

Additionally, although the present study focuses on the emotional demands of eldercare, another theme of the statements made during group interviews was desirableaspects of the job.

ResultsThe major themes from the group interviews that pertain to the emotional demands ofelder care are shown in Table I, along with sample quotes from study participants. Inthis section, we describe the themes in more detail.

Difficult events with patientsTheme 1 concerns unfavorable events with patients that elicit a strong emotionalresponse and/or feelings of uncontrollability. It is comprised of 45 statements, and it isthe theme most prevalently mentioned (Friedmans test; x 2 82:76, p , 0:00, df 4).Many participants mentioned rude and offensive actions by patients. One participant

No. Theme Description Example quotes

1 Difficult eventswith patients

Events with recipients of care thatelicit a negative emotionalresponse and/or are uncontrollable

Ongoing deaths are particularly toughIts stressful that all you see is patientsgetting worse over timeSeeing residents with dementia gets methinking about my fate that I neverwant to get the diseaseEven the most patient person at timeswill have to walk away. Not everyonecan do this jobOn some days, I dont have time toemotionally support the patients, or getsupport myself

2 Work/homeconflict

Strain from work affects non-worktime. Workers feel they completethe same tasks at home as at work

Have emotional demands at home tooMany employees have elderly parentsthey care for after work

3 Patient-familydemands

Concerns and demands of patientsfamilies; hurtful or neglectfulbehavior of family toward patient

Family members will write pages ofnotes for staff on how to take care oftheir family memberIn assisted living families often dumpthe family member and dont visit

4 Money and jobconcerns

Monetary concerns and other jobdemands

Personal care attendants do not make aliving wagePhysically challenging, always liftingand turning peopleStress of people calling off

Table I.Major themes from the

group interviewsregarding emotional

demands (Study 1)


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reported being called nasty [racially offensive] names, and she said it made herwonder if this behavior was part of the condition of dementia, or if that person waslike that before. Other participants said the anxiety present in residents about end oflife issues and seeing patients get worse over time is stressful.

Because Theme 1 comprised nearly half (48 per cent) of the 94 original participantstatements, sub-themes were created. Four of the original 45 statements for Theme 1were found to include multiple emotionally demanding events and were separated,creating 49 total statements. Three co-authors and two graduate assistants examinedthe 49 statements and agreed on four sub-themes that adequately represented most ofthe statements. A fifth theme was added to capture statements that were not includedin the previous four themes. Then, a co-author and two graduate assistants coded the49 statements for Theme 1, resulting in a kappa of 0.91. The four key sub-themesrelated to difficult events are listed in Table II along with sample quotes.

The first sub-theme contains sixteen statements and reflects patient deterioration inthat, patients physical and mental states decline over time. The second sub-theme wasapplied to eleven statements and involves patient aggression against caregivers. Thisincludes physical assault, verbal insults and sexual harassment. Participants reporteda wide range of aggressive behavior ranging from rudeness to sexual groping toviolent outbursts. The third sub-theme was applied to eight statements describing alack of control in care work. Participants described the lack of control over andinability to anticipate patient behavior. The fourth sub-theme described organizationalfactors contributing to difficulties with patients and stress. This was assigned to six

No. Theme Description Example quotes

1 Patientdeterioration

Patients physical and mentalstates continually declining overtime

Its hard to see people do things theywouldnt normally doIts heartbreaking to watch theresidents decline to the point where theycant walk or talk.

2 Patientaggression

Physical assault, verbal insultsand sexual harassment

This job is a lot like working with kids.They dont understand much and can bemean, sometimes call you namesResidents can be combative andsometimes catch you off guard

3 Lack of control Inability to control or anticipatepatient behavior

You might be a friend to a resident oneday and an enemy the next. You justhave to realize that theyre peopleYou can be zippidy-do-dah in themorning and all of a sudden somethingwill happen and youre sucked dry

4 Organizationalfactors

Organizational constraints andlack of respect from co-workerscontributing to emotionaldemands

Nurses aides get blown-off by otherstaff members because, they didnt go tocollege to know when the residents needa shower. This is frustrating because weare not listened to by upper level staffCurrently we are overwhelmed withpatients

Table II.Key sub-themes forTheme 1: difficult eventswith patients (Study 1)

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statements describing difficulties with organizational constraints and a lack of respectand appreciation from nurses and co-workers. Finally, eight statements were coded asthe last sub-theme that included statements that could not be classified as sub-themesone through four, such as comforting patients when they are fearful of dying, orgrieving the loss of other residents.

Work/home conflictTheme 2 involves the idea that job stress affects non-work time and that somecaregivers have additional elder care responsibilities at home. It is comprised of 4statements; it is the theme with the least statements belonging to it. In one groupinterview, it was said that many caregivers take care of elderly parents at home. Oneparticipant shared, Work is a lot easier now, emotionally, that my Dad has passed,indicating that it was difficult for her to be a caregiver both in and out of work.

Patient-family stressTheme 3 refers to the idea that caregivers may experience difficult events with thefamilies of people with dementia. It is comprised of nine statements. It was said thatsome family members do not understand what their loved one is going through,meaning that caregivers not only support the people with dementia, but also theirfamily members. Another participant said that she feels guilty when her patientsappear to like her better than they do their own family, but she believes it is becauseshe spends relatively more time with the person with dementia.

Money and job concernsTheme 4 is comprised of 20 statements about money and job concerns. One participantexplained that, with aging patients and aging staff, there are more work demands andfewer staff members who are able to physically accomplish the tasks required by eldercare. On this point, some of the job requirements (e.g. lifting and turning people) arephysically challenging.

Desirable aspects of the jobOne theme emerged that was less relevant but contained 13 statements; instead ofemotional demands, it focused on favorable features or rewards of the job. As oneexample, study participants complimented fellow staff members (e.g. amazing) andalso the facilities for which they worked. One participant expressed pride in the level ofcare provided by the facility for which she worked, saying, We take people no one elsewants. There was also talk of the meaning and rewards of the work. For example,there was a conversation among participants about the rewards of caring for a personwith dementia who knows my name and who gives me a look that indicates shetrusts me.

DiscussionIn Study 1, we conducted group interviews to better understand the emotionaldemands of elder care that might along with display rules elicit negative suppression.Coding of the qualitative responses resulted in four themes relevant to the issue athand namely, difficult events with patients, work/home conflict, patient-familystress, and money and job concerns. The first theme, difficult events with patients, was


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the one most frequently mentioned, indicating that it may represent a relatively salientcue for emotional labor in elder care. Sub-themes were created and the results showthat the difficult events most frequently mentioned include the declining health ofpatients and being treated aggressively by patients.

As mentioned, previous research indicates that assisting and caring for others is ajob activity that is relatively high in emotional demands (Glomb et al., 2004). However theresults of Study 1 suggest that it is not just caring for others in general that isemotionally demanding, but that there are certain types of events, such as difficultevents with patients (e.g. deterioration, aggression), that may be especially demanding.These affective events or shocks that elicit felt emotion, such as anger (Weiss andCropanzano, 1996), are theorized to motivate employees to use emotional labor strategiesas way of complying with relevant display rules (Grandey, 2000). Other studies in moreprototypical customer environments have focused on, for example, verbal aggressionfrom customers (Grandey et al., 2004), but in the present study aggression from patientsmay include physical assaults, verbal insults, and/or sexual harassment.

Although in our study we did not link these emotional demands with emotionallabor strategies, such as negative suppression, there is previous theoretical andempirical research to suggest such a link may exist (Diefendorff et al., 2008; Grandey,2000). That is, in an effort to comply with organizationally defined guidelines and/orpersonal value systems, direct care providers may exert effort to produce appropriateemotional displays in the face of emotional demands (e.g. patient aggression).

Study 2Emotional labor occurs when employees manage their feelings to create a publiclyobservable facial and bodily display that is appropriate for a given work situation(Grandey, 2000). In her seminal ethnographic research, Hochschild proposed two mainforms of emotional labor, called surface acting and deep acting. Surface acting is anattempt to directly modify displays in situations that have already been appraised,whereas deep acting is an attempt to modify ones feelings about a given situation toproduce the appropriate display. Such efforts may be governed by display rules,defined as organizational expectations about appropriate emotional expression(Hochschild, 1983). In this way, emotional labor is directed toward the suppression ofinappropriate emotion (e.g. frustration) and the expression of appropriate emotion(e.g. enthusiasm) at work (Glomb and Tews, 2004).

Reviews of emotional labor emphasize that it is a multi-dimensional construct, withcertain forms or dimensions having potentially negative consequences for employeewell-being (Wharton, 2009). Surface acting, in particular, has been found to relatenegatively to job attitudes (Bono and Vey, 2005), to drain attentional resources(Goldberg and Grandey, 2007), and to predict turnover through emotional exhaustion(Chau et al., 2009). Similarly, Pugliesi (1999) found activities such as being artificiallynice, which is akin to surface acting, to be associated with single-item measures of jobsatisfaction and job stress (i.e. less satisfaction, more stress). For deep acting, on theother hand, the literature is less clear. Some studies have found deep acting does notrelate significantly to job satisfaction (Johnson and Spector, 2007; Judge et al., 2009),whereas other studies have reported deep acting to be associated with a greater senseof personal accomplishment (Brotheridge and Grandey, 2002; Brotheridge and Lee,2002, 2003).

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An alternative to measuring the internal processes of surface and deep acting is toinstead focus on behavioral displays (Ashforth and Humphrey, 1993). This approachbears the advantage of greater clarity about what is being measured, as well as theability to distinguish between positive and negative emotions. In the present study, weuse the conceptualization of emotional labor by Glomb and Tews (2004), who define theconcept as the behavioral expression and non-expression of felt or unfelt emotions inaccordance with display rules. More specifically, we focus on non-expression of feltnegative emotions, called negative suppression. This focus is similar to early interests inthe concept of suppressive work the act of inhibiting the display of an emotion thatwould be inappropriate to the social situation if expressed (Hochschild, 1979). Moreover,negative suppression is linked to an acute increase in sympathetic nervous activity(e.g. Gross and Levenson, 1997), which over the longer term predicts all-cause mortalityand incidence of coronary heart disease and hypertension (Mauss and Gross, 2004).

In Study 2, we examined the empirical association between negative suppressionand job attitudes. There is theoretical support for this link; as explained by Grandey(2000, p. 103):

[. . .] provided that the events induce emotions that are discrepant from display rules, moreevents should result in more effort to regulate emotions, and so should have a cumulativeeffect on stress and well-being.

There also exists field research on negative suppression and its association with jobattitudes. The perceived work requirement to hide negative feelings has been shown torelate to burnout and to ill health (Brotheridge and Grandey, 2002; Schaubroeck andJones, 2000), and negative suppression itself has been shown to relate to lower levels ofjob satisfaction, even after controlling for emotional expressivity (Cote and Morgan,2002; see also Grandey et al., 2005). However, in the present study, we tested whethernegative suppression relates to job attitudes after controlling for individual differencesin general mood. This control was necessary from a practical perspective in that wewanted to establish for human resource managers that any relationships foundbetween negative suppression and job attitudes would hold true, so to speak,regardless of a direct care providers standing in general affectivity.

Thus, taking into consideration the existing research to suggest that individualdifferences in positive affectivity (PA) and negative affectivity (NA) may relate toemotional labor (Bono and Vey, 2005) and to job attitudes (Judge and Larsen, 2001; Smith,1992), we tested for the presence of relationships between negative suppression and jobattitudes that exist apart from relevant associations with PA and NA. The specific form ofour hypotheses was that the more frequently that people report suppressing negativeemotions at work (e.g. anger), the more likely they will be to report feeling higher in jobstress and lower in job satisfaction, which we define as the feelings people have about agiven job situation (Ironson et al., 1989; Smith et al., 1969; Stanton et al., 2001). That is:

H1. Negative suppression will relate positively to job stress.

H2. Negative suppression will relate negatively to job satisfaction.

MethodParticipants and procedure. Direct care providers working in the Midwestern UnitedStates were recruited to participate in the study through flyers posted at their


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employing organizations (e.g. in break rooms). Of the 75 direct care providers whoresponded to our survey, the majority was female (86 per cent), white (83 per cent),aged 40 or older (72 per cent), and had worked at the employing organization for fewerthan ten years (79 per cent). The three organizations were different in care type; henceparticipants worked in a nursing home (n 14), in an assisted living facility (n 40),or in home health care (n 21). After the survey, participants took part in the first ofthree training sessions related to dementia care, for which they had the opportunity toreceive continuing education credits[1].

Measures. Negative suppression. A subscale of the DEELS (Discrete Emotions Emotional

Labor Scale; Glomb and Tews, 2004) was used to measure negative suppression;this scale has previously been shown to be associated with emotional exhaustion.The instructions prompted respondents to think about their emotions at workduring the past month, asking them to consider such things as their body language,facial expression, and tone of voice. This subscale included nine negative emotions(e.g. anger, sadness) and asked participants to rate during a one-month period thefrequency with which they kept the emotion to themselves. The response formatwas a five-point scale with respondents choosing from Many times a day (5),A few times a day (4), A few times a week (3), A few times a month (2) andNever (1). The subscale demonstrated good reliability (a 0.91).

. Job satisfaction: job in general ( JIG). The JIG was used (Balzer et al., 1997; Ironsonet al., 1989) to measure satisfaction with the job in general. This scale haspreviously been shown to relate to a number of variables, including intentions toleave (Ironson et al., 1989). The instructions ask the participants to indicatewhether or not various adjectives or short phrases (e.g. pleasant) describe thejob by choosing Yes, No, or ? (if they cannot decide). Per Smith et al. (1969),a response of Yes was scored with a 3, No was scored with a 0, and ? wasscored with a 1. The JIG demonstrated good reliability (a 0:80).

. Job stress: stress in general (SIG). The SIG (Stanton et al., 2001) was used tomeasure job stress. This scale has previously been shown to relate to a number ofvariables, including intentions to leave (Stanton et al., 2001). It contains twosubscales, SIG-I (seven items) and SIG-II (eight items), which respectivelymeasure less and more serious levels of stress. Items on SIG-II include hassledand overwhelming; items on SIG-I include hectic and demanding. Theinstructions ask the participants to indicate whether or not these adjectives andshort phrases describe their job by choosing Yes No or ? (if they cannotdecide). Per Stanton et al., a response of Yes was scored with a 3, No wasscored with a 0, and ? was scored with a 1.5. The SIG subscales demonstratedgood reliability: a 0:91 for SIG-I and a 0:78 for SIG-II.

. Affectivity: PA and NA. The PANAS (Positive and Negative Affect Schedule;Watson et al., 1988) was used to measure individual differences in positiveaffectivity (PA) and negative affectivity (NA). This scale has previously beenshown to relate to number of variables, including psychological distress anddysfunction (Watson et al., 1988). Participants were asked to rate the extent towhich they generally feel certain emotions, including ten emotions that arepositive (e.g. excited, active) and ten that are negative (e.g. irritable, guilty). Items

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were rated on a five-point scale ranging from Not at all to Extremely. Bothscales were shown to be reliable: a 0:91 for PA and a 0:71 for NA.

. Demographics. Questions about sex, race, age, and job tenure were included atthe end of the survey. In addition we maintained a record of the facility for whicheach respondent worked.

ResultsPreliminary analyses. Preliminary analyses revealed mean differences in negativesuppression by type of workplace; therefore we created a binary control variable (homehealth versus not) for use with all hypothesis tests. The analyses we conductedincluded a one-way ANOVA to examine whether respondents reported any differencesin the frequency with which they engaged in negative suppression depending on thetype of facility for which they worked (i.e. nursing home, assisted living, home healthcare). The results revealed differences by facility (F2; 63 3:80, p , 0:05), such thatrespondents were less likely to report engaging in negative suppression if they workedin home health care (M 2:20, SD 0:60) versus a nursing home (M 3:00,SD 1:00; D 0:80 [0.33], p , 0:05) and versus assisted living (M 2:70,SD 1:10; D 0:60 [.26], p , 0:05).

Analytic approach. Based on our review of relevant research, we identified negativeaffectivity (NA) and positive affectivity (PA) as control variables. When testing therelationship between negative suppression and job stress (i.e. SIG-I, SIG-II), wecontrolled for the associations between all variables and NA; when testing therelationship between negative suppression and job satisfaction, we controlled for theassociation between negative suppression and NA and between job satisfaction andPA. Based on the preliminary analyses, we also controlled for whether or notrespondents worked for home health care (i.e. yes, no) on negative suppression. Toappropriately model these control variables, each hypothesis was tested separatelywith path analysis following the procedures of Kline (2005) with the correlation matrixshown in Table III. All path models showed acceptable or good fit, as indicated by thecomparative fit index (CFI), root mean square of approximation (RMSEA), andstandardized root mean square residual (SRMR) reported in the next section; however,it is the standardized beta weight (b) or association between relevant variables that isused for hypothesis testing.

M SD 1 2 3 4 5 6 7

1 Negative suppression 2.63 0.96 (0.91)2 Job satisfaction ( JIG) 2.31 0.48 20.37 * * (0.80)3 Job stress (SIG-I) 1.99 1.06 0.36 * * 20.16 (0.91)4 Job stress (SIG-II) 1.17 0.89 0.24 20.25 0.67 * * (0.78)5 Positive affect (PA) 3.78 0.83 20.03 0.30 * 20.09 20.19 (0.91)6 Negative affect (NA) 1.54 0.40 0.35 * * 20.30 * 0.47 * * 0.57 * * 0.11 (0.71)7 Home health 0.33 0.47 20.38 * * 0.15 20.09 20.16 0.13 20.12 n/a

Notes: * p , 0.05, * * p , 0.001; Listwise n 62; Coefficient alphas indicated on diagonal. Homehealth is a binary variable (yes, no), job attitudes (JIG and SIG) use a three-point response format (Y, N, ?),and remaining variables use a five-point response format

Table III.Descriptive statistics and

listwise correlations forstudy variables (Study 2)


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Hypothesis tests. Partial support was found for Hypotheses 1, which posited thatnegative suppression would relate to job stress. The direct path from negativesuppression to SIG-II (i.e. more serious job stress) was non-significant (b 0:05,p . 0:05; x 2 1:49, df 2, CFI 1:00, RMSEA 0:00; SRMR 0:06); however, thedirect path to SIG-I (i.e. less serious job stress) was significant and in the hypothesizeddirection with b 0:23 (p , 0:05; x 2 1:10, df 2, CFI 1:00, RMSEA 0:00;SRMR 0:04).

Support was found for H2 with a significant, direct path from negative suppressionto JIG (general job satisfaction) in the expected direction with b 20:27 (p , 0:05;x 2 2:76, df 5, CFI 1:00, RMSEA 0:00; SRMR 0:06).DiscussionIn Study 2, two hypotheses were tested about the relationship between negativesuppression and job attitudes. Support was found for the second hypothesis in thatnegative suppression was associated with less job satisfaction. Support for thisrelationship has been found previously in a sample of working college students(albeit with different control variables; Cote and Morgan, 2002), but here we show itin the context of elder care. Partial support was found for the first hypothesis inthat negative suppression was found to relate to one of the two subscales of jobstress (SIG-I); this is the first study of which we are aware linking negativesuppression with job stress.

This general pattern of results in combination with existing theory (Grandey, 2000)lend support to the idea that negative suppression is associated with less jobsatisfaction and more job stress, even after accounting for individual differences inpositive affectivity (PA) and negative affectivity (NA). Thus, from the perspective ofhuman resource management, the results suggest that negative suppression isassociated with undesirable job attitudes, regardless of the general mood of a givenemployee.

A potential criticism of this study lies in the fact that all of the data were collectedwith participant self-reports. Chan (2009) explains the problems associated withself-report data include the:

. construct validity of the measures;

. interpretation of resulting correlations; and

. socially desirably response patterns.

Campbell (1982) is biased against studies that use self-report to measure all variablesif there is no evident construct validity (p. 692, emphasis added). Thus, a strength ofour study is that its measures, though self-report, are previously validated. Regardingthe possibility that observed correlations are inflated due to common method variance,the fact that we included PA and NA as control variables in our path models addressesthis to a degree. Podsakoff et al. (2003) explain this strategy for controlling method biasis somewhat limited in that only controls for that portion of common method variancethat is attributable to, in this case, PA and NA. Finally, regarding social desirability,Chan (2009, p. 319) suggests this is probably the most often cited criticism ofself-report data and defines it as the tendency to present ones self in a way that isfavorable with regard to culturally derived standards (Ganster et al., 1983). Thus, in thesurvey development stage, we selected measures that avoid value-laden content that

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invokes a need to present a favorable impression in the first place. With negativesuppression, for instance, the measure by Glomb and Tews (2004) asks respondents toindicate the frequency of non-expression of felt negative emotions, as opposed tomeasures of similar constructs (like surface acting) that make reference to things likefaking, which some respondents may be motivated to conceal. Also, followingPodsakoff et al., we not only kept our survey items simple, specific, and concise, but wealso used different scale endpoints and formats for the predictor and criterionmeasures. In sum, we have no reason to doubt the general pattern of relationshipsfound between negative suppression and job attitudes.

General discussionThe supply-and-demand problem in elder care is one that will require increasingattention on the part of society. For human resource management, one question is howto break the vicious cycle of vacant shifts, job stress, and turnover that characterizessome elder care organizations (Eaton, 2000, 2001). In the present investigation, wefocus on the suppression of negative emotions as a possible point of organizationalintervention. We conducted group interviews to better understand the emotional jobdemands of elder care (Study 1), and we administered a survey to examine theempirical association between negative suppression and job attitudes (Study 2).

Taken together, the results provide support for the theory that difficult events withpatients interact with display rules to elicit emotional labor, which in turn is associatedwith job attitudes (Grandey, 2000). The results of group interviews (Study 1) suggestthat difficult events with patients, such as patient deterioration and patient aggression,are among the emotional job demands of elder care. The survey results (Study 2)generally suggest that negative suppression is associated with lower job satisfactionand with greater job stress, regardless of a direct care providers standing in generalaffectivity. These two studies are linked to the extent that direct care providers managedifficult events by working to conceal or suppress felt emotion (e.g. sadness, anger), butfuture research needs to examine whether negative suppression acts as a mediator ofthe association between difficult events and job attitudes; moreover, these models needto be expanded to include intentions to quit and actual turnover (e.g. Chau et al., 2009).

One possible way to recover from negative suppression is to use emotionaldisclosure, which is the verbalizing of felt emotions to another person (Smyth andPennebaker, 1999; see also McCance et al., in press). In a recent experimental studyconducted in the laboratory (Daniels et al., 2010), post-suppression emotionaldisclosure resulted in lower reports of emotional exhaustion as compared to factualdisclosure, but only for individuals relatively low in neuroticism; for those high inneuroticism, post-suppression emotional disclosure unexpectedly resulted in greaterreports of emotional exhaustion. This pattern of findings suggests that there is thepotential for emotional disclosure to buffer the stressful effects of negativesuppression; however, the results also underscore the need for field research tomeasure emotional disclosure as it happens naturally. Also worth considering in futureresearch are alternatives to negative suppression i.e. healthier ways to manageemotional demands at work (e.g. reappraisal; see Gross and Thompson, 2007).

Another direction for future research is to focus more on display rules, as this isa component of the emotional labor process over which organizationaldecision-makers may have relative control, including when employees are on


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and off at work. Observational research with call center operators, for example,suggests that it is common to hear outbursts about difficult customers (Bolton andHoulihan, 2005). In this way, call centers may have a backstage where displayrules do not necessarily apply, as customers are not present, and thus emotions(even negative ones) may be freely expressed, if only briefly. However, in elder care,there is not always a backstage. That is, there is not necessarily a time or place fordirect care providers to talk about the demands of the job, much less to get awayfrom those demands. Future research could more systematically examine theresources available to direct care providers (e.g. break rooms) and whether thisrelates to outcome measures of interest.

Up until now our discussion has focused entirely on interactions between direct careproviders and their patients. Importantly, though, a limitation of Study 2 is that ourmeasure of negative suppression did not ask when or with whom the respondents usenegative suppression at work. The results of Study 1 point to difficult events withpatients as a job demand that may elicit negative emotion, which based on theory(Grandey, 2000) we use to suggest may relate to undesirable job attitudes throughnegative suppression. However, previous research suggests that the events that elicitemotional labor strategies are distributed across customers, co-workers, and managers(Basch and Fisher, 2000; Diefendorff et al., 2008). Thus, in Study 2, the target fornegative suppression could be a patient, but it could also be a co-worker, manager, oreven a family member of a patient. In future research on this topic it would beinteresting to include different targets on a given survey. Seery and Corrigall (2010) didthis with nurses aids and childcare workers, with the targets being clients andfamily members of clients; the authors found that certain links between emotionallabor and job satisfaction were significant for one target but not the other. Mostrelevant to the present investigation is the finding that the relationship betweensurface acting (which involves negative suppression) and job satisfaction was onlysignificant when the surface acting was performed for clients (i.e. not for clients familymembers).

Although our focus here has been on the USA, we conclude by highlighting that thesocietal need for elder care exists worldwide. A recent report by Kinsell and Wan (2009)provides much evidence in support of this point. First, the worlds population is aging,and by 2020, it is expected that people aged 65 and over will outnumber children underage 5 for the first time in history. Second, although the majority of older peoplecurrently reside with their family, intergenerational co-residence is on the decline.Third, the use of professional long-term care for the elderly is becoming increasinglycommon (especially in Southeast Asia), as the worlds population is aging rapidly whilethe number of potential family caregivers is declining. Related, the increasingprevalence of dementia is leading a number of researchers and medical practitioners toraise warnings about the growing need for professional long-term care facilities andproviders. Here we suggest that studying negative suppression and its implications forhuman resource management is one way to improve working conditions for direct careproviders, thereby helping to enhance recruitment and retention in this valuableprofession.

Note

1. For a detailed description of study procedures, please see Gillespie et al. (2006).

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About the authorsJennifer Z. Gillespie, PhD, is an Adjunct Professor in the Department of Psychology at Universityof South Florida Sarasota-Manatee. Her specialty is Industrial-Organizational Psychology, andher research interests include work motivation, emotional labor, and job satisfaction. She haspublished her research in the Journal of Applied Psychology, Journal of Business and Psychology,Journal of Applied Social Psychology, and Stress and Health. Jennifer Z. Gillespie is thecorresponding author and can be contacted at: [email protected]

Patricia B. Barger earned her PhD in Industrial-Organizational Psychology from BowlingGreen State University in 2009. Her research interests include emotional labor, work stress andcustomer service. Her work has been published in such journals as Academy of ManagementJournal and Consulting Psychology Journal. She currently works as an Assessment Scientist forKronos, Inc.

Jennifer E. Yugo is an Assistant Professor of Management at Oakland University. Shereceived her PhD in Industrial and Organizational Psychology in 2009 at Bowling Green StateUniversity. Her research interests include the meaning of work, emotional labor, employeewellbeing and positive organizational scholarship. She has published her research in severaloutlets including the Journal of Applied Psychology.

Cheryl J. Conley, MA, LSW, is Program Director at the Alzheimers Association, NorthwestOhio Chapter. She has worked in the field of aging for more than 20 years, including regionalcoordinator of a geriatric education center, director of social services for a county committee onaging, and adjunct gerontology faculty. Her research interest is in providing practicalinterventions for assisting families of persons who have dementia (Dementia: The InternationalJournal of Social Research and Practice). She is also interested in studying older adults whoreturn to college and on-campus residences for older adults.

Lynn Ritter, PhD, is the Education Coordinator at the Alzheimers Association, NorthwestOhio Chapter, a position she has held for over ten years. She is responsible for planning andimplementing professional training. Her dissertation compared staff training programs atselected dementia-specific LTC facilities. She wrote a chapter in Dementia Units in Long-TermCare, Developing a therapeutic activities program in a dementia unit. She also worked foralmost 12 years in an LTC facility as activities coordinator, then director of the facilitysAlzheimers Special Care Unit, the first such unit in northwest Ohio.


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