Nursing, Emotional Labour and Toxic Absence

One of the most frustrating parts of a research project is securing the first publication. You can spend months collecting data, weeks analysing it and just as long (or more!) writing up a journal article but finding a “home” for that piece of work can be a lengthy and stressful process. This can be especially exasperating when the subject matter of the research is time-sensitive and sharing the findings through a reputable outlet is important to contribute to a greater understanding of a current public debate. Given the length of time a typical journal review process takes from start to finish (at least a year with multiple revisions of the paper likely) and the high likelihood of rejection (roughly 5-10% success rate in top journals), academic publishing can be a drawn-out and anxiety inducing process.  

This has undoubtedly been the case for a recent project. As covered in a previous blog, my colleagues and I conducted research throughout the pandemic on critical care nursing and we are keen to share the results. The findings speak to many of the recent issues in the NHS such as staffing issues faced throughout the pandemic as well as the nursing strikes and calls for better working conditions and pay. Whilst we were keen to get our findings published (so it can potentially contribute to these debates) there is, of course, the need to find the right “home” which has slowed down our progress at times. 

Over the past month, however, our research team has made a breakthrough with the publications process securing two outputs. Led by Prof. Robert McMurray (Royal College of Surgeons in Ireland), we have had an article accepted in the Journal of Nursing Management entitled “Toxic absence: Why Leader Presence Matters in Times of Crisis”. The pre-publication version of the paper can be read here and overview of the paper can be found below:

Aim(s) – This study examines the importance of senior-leader presence on the ‘front-line’ in times of crisis.

Background – The COVID-19 pandemic placed unprecedented demands on nurses charged with delivering critical care. Extant research suggests that the active presence of ward level leaders has an important role to play in supporting front-line staff and mediating the negative impacts of stress and burnout.  There is little evidence on the impact of senior leader presence or absence on the experience of frontline critical care nurses, particularly at times of crisis. 

Method(s) – A three-phase qualitative interview study of critical care nurses in the UK and Ireland.  A total of 107 semi-structured interviews with 54 nurses representing 38 different healthcare units.

Results – Senior-leader presence at time of crisis serves as an important symbol of organisational support.  Where senior leaders are not meaningfully present, they risk allowing the necessary pain of difficult work situations becoming toxic. Toxicity is manifest in increased staff stress, emotional ills, absence and turnover. 

Conclusion(s) – Senior-leaders must balance their responsibilities for strategy and structures with the frontline presence required to shape a positive emotional climate.  

Implications for Nursing Management – Senior managers should consider supplementing their strategic focus with punctuated returns to the floor.  Symbolically, leaders who get their hands dirty embody a sense of mutual struggle and practical support.  Managerially, time on the floor increases the opportunities for collecting primary data to improve decision-making and support.  

This article follows from another recent publication in the form of a book chapter on emotional labour of critical care nurses during the pandemic. The book chapter entitled “Emotional Labour: Concept and Practical Categorizations in Light of Covid Critical Care Nursing” has been published in a new Routledge book “Shifting Categories of work: Unsettling the ways we think about Jobs and Activities”. A pre-publication version of the chapter can be read in full here. Both publications reflect the extremely difficult working experiences of critical care nurses during the pandemic, exploring the various problems that nurses faced on their wards due to issues around absent leadership and the intensification of work. 

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