Exploring the Relationship Between the Explicitness of Emotional Display Rules and Well-Being among Nurses: The Mediating Influence of Rules’ Internalization

Abstract

This study contributes to our understanding of the processes through which the explicitness of display rules is linked to nurses’ well-being. Based on control theory and professional role theory, our model posits that the explicitness of display rules has a positive relationship with job satisfaction and work engagement. A cross-sectional study was carried out on 407 nurses working in a Belgian hospital. Structural Model Analyses was performed. Results indicated that the explicitness of emotional display rules increases nurses ‘s well-being. This relationship is mediated by the internalization of emotional rules. Implications for organizational practice were discussed.

Keywords: Emotional display rules; Internalization of emotional rules; Job satisfaction; Work engagement

Introduction

Nurses face with fast developments, emotional demands and continuously changing practice which may make emotional display rules very significant [1]. Emotional display rules consist of “shared beliefs or norms about emotional displays” [2, p6]. They are circulated by organizational culture as well as managerial practices [3] and can vary depending on professional norms [4]. There are expectations among employees of how they should behave emotionally.Emotional display rules consist of the standards about the suitability of emotional displays in work settings [2]. However, the impact of display rules on job performance and well-being was not clear [5]. In the present research, our aim is, first, investigate the impact of explicitness of emotional display rules on nurses’ well-being. Second, we examine how the internalization of the emotional display rules mediates the relationships between the explicitness of display rules and nurses’ job satisfaction and work engagement.

Literature Review and Hypothesis

Emotional display rules are not only prescribed emotional expressivity, but also emotional directions for a specific professional role, which can lead to an agreement with organizational norms [2,4]. Emotional display rules play a key role in shaping the quality of care and affect the reputation and performance of hospitals [6].

Organizations can be distinguished according to whether or not they explicit emotional rules that serve as standards for the appropriate expression of emotions [7]. The explicitness of display rules is the strength with which an organization transmits emotional display rules [8]. The explicitness of display rules may vary across organizations and range from the absence of prescription to the intense communication of requirements [9]. The explicitness of display rules is independent of emotional display rule content, which may include positive, neutral, or negative expressions [8, p249]. In line with control theory, the explicitness of display rules regulate employee emotional expressions to facilitate the achievement of organizational goals. The explicitness of display rules is indispensable in organizations because communicating the right amount of information regarding emotional display rules motivates employees to activate resources in order to achieve emotional requirements [8].

The Relationship of Explicitness of Display Rules with work Engagement and Job Satisfaction

Work engagement is defined as a “persistent, pervasive and positive affective-motivational state of fulfilment” [10, p417]. It includes three components: vigour, dedication, and absorption [11]. Engaged nurses are patient-centered and focused on quality of care [12]. Despite the numerous research on emotional labor, the effect of emotional display rule on work engagement was not clear [13]. In the literature, there are two opposing approaches about the effect of emotional display rules on work engagement, the resource depletion theory, and the control theory [13,14]. The resource depletion theory suggests that emotional display rules need employees to spend efforts to conform to emotional display rules which can leads to emotional exhaustion [15] as well as weaker job satisfaction [16]. When a nurse must show positive emotions, like compassion or empathy for each patient, it requires energy and emotional resources [14]. According to control theory, emotional display rules encourage nurses’ normative goals, standardize and make the emotional content of interactions between nurses and their patients more predictable. Hence, emotional display rules make social interactions with their patients easier [15].Stark & Bettini [16] found that teachers considered that display rules help them spotlight students’ emotional needs, and not get preoccupied by their own particular emotions. In the same vein, Liu & Cho [17] discovered that emotional display rules increase work engagement in Chinese hotel employees. The explicitness of emotional display rules can be seen by employees as a resource, which thus could foster their work engagement. Thus, these authors incite future research to evaluate the impact of emotional display rules on work engagement in other countries to corroborate this proposition [17]. Based on these arguments, we argue that the explicitness of emotional display rules is positively associated with work engagement

H1: There is a significant positive relationship between the explicitness of emotional display rule and work engagement.

Nurses’ job satisfaction is fundamental to maintain an efficient work force in hospitals. Job satisfaction deals with the achievement of the work itself. It includes factors like “responsibility, self-directiveness, skill development, and observed accomplishment associated with performing the work” [17,18, p597]. The explicitness of display rules gives information about employees’ work role expectations [2] and helps workers prevent distressing interpersonal problems [19] A lack of suitable information about role expectations is negatively associated to job satisfaction [20]. We suggest that the explicitness of display rules, because it facilitates emotional interactions by making them more predictable and give information about employees’ work role expectations improve job satisfaction.

H2: There is a significant positive relationship between the explicitness of display rules and intrinsic job satisfaction.

The Mediating Influence of the Internalization of Display Rules on the Relationships between Explicitness of Display Rules and Job Satisfaction

Most research on emotional regulation is based on the implicit statement that when employees perceive emotional display rules, they make efforts to display expected emotions [5] Adhering to emotional display rules is believed as a particular in-role requirements [13]. Few studies have examined the way and the degree to which employees agree with emotional display rules [2]. Most of the time, emotional labour studies presume that employee behaviours conform to display rules, but theory on goal-performance discrepancies indicates that this is not always the case. It may depend on the fact that the cognition of the rules is considered relevant, despite the fact that they are performed for extrinsic reasons [21]. Thus, the process of rules’ internalization starts with learning what the norms consist of, then individual goes through a process of understanding why they are of value or why they make sense, until finally they accept the norm as their own viewpoint.The internalization of display rules is viewed as a practical necessity because prescribed emotions like compassion and happiness play an important role in the development of positive customer perceptions of service quality, especially in the health care sector [22]. In particular, emotional display rules interact with individual level affectivity to predict employees’ use of emotion regulation strategies [13]. There is some evidence that when nurses internalize emotional display rules, this process may contribute to express a genuine sense of caring [5,23]. In this situation, individuals perform emotional display rules not merely to obtain rewards or avoid penalties, but because emotional display rules are perceived as values. Internalizing display rules leads individuals to accept them [24]. According to the Self Determination Theory [21,25], individuals who internalize their organization’s norms, show a higher degree of job satisfaction and work engagement [26]. As such, display rules are similar to organizational norms prescribing how workers should perform in social exchanges [13] In this case display rules have been viewed as essential parts of the professional role [27]. Emotional display rules can be understood as what one might accept to be professionally appropriate, and it can foster satisfying experiences at work [28]. Fail to adhere to display rules is judged as unprofessional [13].

Furthermore, the internalization of display rules provides the motivation to express the required emotions [21]. The process of incorporate a set of norms is an important element in fostering nurses’ job satisfaction and work engagement [29].

H3: There is a significant positive relationship between explicitness of display rules and job satisfaction by adhering to emotional display rules.

H4: There is a significant positive relationship between explicitness of display rule and work engagement by adhering to emotional display rules.

Methodology

Participants, Design, and Procedure

This cross-sectional study was conducted in a Belgian hospital. The sample consists of 470 nurses working in a Belgian hospital. The inclusion criterion was employed for more than half a year in the hospital.Healthcare managers of the hospitals were informed about the study and agreed to participate. Nurses were informed about the study via meetings with the researchers. A paper questionnaire was given to the nurses during working hours. The questionnaires included a section with demographic data as well as the different scales assessing the study variables. Participation in the study was voluntary and the questionnaire anonymous. The distribution and completion of the questionnaires were carried out at their workplace with the assistance of the nurse coordinators.

Figure 1: Conceptual model of the mediation relationship.

    


    


    Figure 1: Conceptual model of the mediation relationship.

    

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Measures

We translated English-language items into French and Dutch using a standard translation-back translation procedure.

Explicitness of display rules. Zapf ’s Frankfurt Emotional Work Scale [30] was used to measure the degree of explicitness in Emotional display rules (e.g: “Emotional display rules have been passed on to me in continuing education courses organized by the hospital”). The answers are given using a 5-point Likert scale from 1: very rarely/never to 5: very often. We used the 3 items that assessed the explicitness of display rules.

Emotional Rules Internalization. The process of internalization of emotional rules was assessed by the Dal Santo, Pohl & Battistelli [23] scale. The scale consists of 3 items. A five-point scale was used to answer each item (e.g.: Emotional display rules in force in my service seem relevant to me).

Job satisfaction. Job satisfaction was assessed using the short form of the Minnesota Satisfaction Questionnaire (MSQ) [31]. A five-point scale was used to answer each item (e.g.: I am satisfied with a sense of fulfilment generated by my job).

Work engagement. Work engagement was measured by using the Utrecht Work Engagement Scale [32]. The scale consists of 9 items with a three-factor structure which includes the vigor, dedication, and absorption sub-dimensions. Each item was answered on a seven-point scale. A sample item included: “I’m full of energy while I’m working”.

Ethical Approval

The approval to carry out the research was obtained from ethical committees at the lead University according to the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Results

Following Anderson and Gerbing’s [33] recommendations, the data was analysed in two phases. First, we tested the measurement model to determine the distinctiveness of the constructs used in this study. In the second phase, we tested the hypothesized relationships among latent variables using the structural equation modelling, through Mplus.

Measurement Model

To investigate the independence of the constructs, a measurement model including all scales from the questionnaire was tested by Confirmatory Factor Analyses with Mplus. Our measurement model includes four latent variables: Explicitness of display rule, adherence to display rules, work engagement and job satisfaction. The overall goodness-of-fit for this model was adequate: Chi-Squared (Χ2)=193.005**; df=98; p<0.0000; Comparative Fit Index (CFI)=0.961; Tucker–Lewis index (TLI)=0.952; Root Mean Square Error of Approximation (RMSEA)=0.047 and SRMR=0.047. This model proved to be superior to 1-factor models that merged all study variables (chi-squared (Χ2)=1224.708**; df=104; p<0.000; Comparative Fit Index (CFI)=0.538; Tucker–Lewis Index (TLI)=0.467; Root Mean Square Error of Approximation (RMSEA)=0,155 and SRMR (Standardized Root Mean Square Residual)=0.144). These results confirm the distinctiveness of our study’s variables.

Descriptive Statistics

The means, standard deviations, reliabilities, and correlations among the variables, are displayed in Table 1.

Table 1: Means, standard deviations, reliabilities and correlations.

  


    
 

    
M

    
SD

    
1

    
2

    
3

    


      


    

  

  


    
EDR

    
 

    
 

    
(0.75)

    
 

    
 

    
 

  

  


    
IDR

    
3.12

    
.83

    
,48**

    
(0.82)

    
 

    
 

  

  


    
WE

    
 

    
 

    
 

    
 

    
(85)

    
 

  

  


    
JSAT

    
3.75

    
.53

    
,31**

    
,37**

    
,38**

    
(0.81)

  

  


    
Note: EDR: Explicitness of Display Rules; IDR:    Internalization of Display Rules, WE: Work Engagement; JSAT: Job    Satisfaction. Alpha coefficients are reported in parentheses along the    diagonal. **p<.01. 

  

Table 1: Means, standard deviations, reliabilities and correlations.

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As can be seen, all variables displayed good internal consistency (a> .70).

Structural Model Analyses

We tested the hypothesized model (paths from explicitness of display rule to work engagement and job satisfaction through internalization to display rules using Mplus. This model fitted the data well: 2=204,561*; p<.001; df=100; RMSEA (root-mean-square error of approximation)=0,05; CFI (Comparative Fit Index)=.96; TLI (Tucker–Lewis Index): 0.95. Table 2 shows the estimated path coefficients, the standard error of the estimates, and the p-value for the direct and indirect effects on each dependent variable (Table 2).

Table 2: Direct and Indirect effects of explicitness of display rules on work engagement and job satisfaction.

  


    
 

    
WE

    
JSAT

    
IDR

  

  


    
 

    
Β

    
p

    
Β

    
p

    
Β

    
p

  

  


    
EDR

    
0,12

    
0,1

    
,17

    
,00

    
,36

    
,03

  

  


    
IDR

    
0,10

    
0,02

    
,40

    
,00

    
 

    
 

  

  


    
EDR on WE via IDR

    
0,09

    
0,02

    
 

    
 

    
 

    
 

  

  


    
EDR on JSAT via IDR

    
 

    
 

    
0,38

    
0,04

    
 

    
 

  

  


    
Note: EDR: Explicitness of Display Rules;    IDR: Internalization of Display Rules, WE: Work Engagement; JSAT: Job Satisfaction.


      ***:p<0,001;    **:p<0,01 

  

Table 2: Direct and Indirect effects of explicitness of display rules on work engagement and job satisfaction.

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Hypothesis 1 and hypothesis 2 that predicted a direct positive relationship between explicitness of display rule and work engagement and between explicitness of display rule and job satisfaction are supported (Β:0.12 p<.05; Β:0.17 p<.05). Hypothesis 3 and hypothesis 4 which predicted that explicitness of display rule has an indirect effect on work engagement and on job satisfaction are also supported. The indirect path between explicitness of display rule and work engagement via internalization to display rules and between explicitness of display rule and job satisfaction via internalization of display rules are statistically significant (Β:0,09; p<.001 and Β:0,38; p<.001).

Discussion

Our study aims to better understand the role played by explicitness of display rules and the internalization of emotional rules on nurses’ well-being.

Our results show that, according to the professional role theory, explicitness of display rule is essential in the context of health care. In particular, explicitness of display rule has a positive relationship with work engagement and job satisfaction. Explicitness of display rule also make work transactions more predictable and help workers to recognize the appropriate ways to behave at work [2]. Disseminating enough information about emotional display rules may stimulate nurses to regulate their interactions with patients in order to improve the quality of these interactions and subsequently improve their work engagement. Moreover, explicitness of display rule could develop a shared emotional climate which could help nurses to regulate their own emotions and thus improve job satisfaction [34]. These positive consequences of explicitness of display rule on job satisfaction and work engagement play a fundamental role in the nursing context, where the emotional workload and the requirement to perform emotional tasks can be overwhelming. This positive relationship between explicitness of display rule on nurses’ well-being seems to be brand new and moves beyond the traditional focus on the association between display rules and performance.

Moreover, our results demonstrate that the relationships between explicitness of display rule and job satisfaction and between explicitness of display rule and work engagement are mediated by the internalization of emotional rules. According to the control theory, explicitness of display rule reduces nurses’ emotional expressions to help achieve organizational goals [8].When nurses display emotions that are perceived congruent with their values and goals, they experience job satisfaction and work engagement. Moreover, according to the Self Determination Theory [21], when employees internalize emotional rules, they adopt them as their own point of view. Emotions reflect individuals’ personal identity, so what they express emotionally is important to them [35]. When individuals express their emotions, they determine the extent to which their behavior is consistent with their personal views [36]. From this discordance– congruence perspective [37], the degree to which emotional displays are authentic is said to be the key difference [38] The accordance between nurses’ genuine feelings and display rules contributes to express a genuine sense of caring [26]. Health care professionals who are perceived to be more emotional genuine are more likely to have a positive interaction with patients [22]. This spiraling effect could have a positive role in fostering nurses’ engagement and job satisfaction.

Practical Implications

These results have several practical implications. Firstly, this study provides insights that are useful for hospitals on how to increase nurses’ satisfaction and nurses’ work engagement. For example, our results highlight the importance of considering emotional display rules as explicit suggestions to make working behaviors more predictable and less strenuous. Nurses should be trained and made aware of the unavoidable workload with emotional display rules. Moreover, nurses should be helped to consider explicitness of display rule as their own choice. Accepting emotional rules could foster activities that help to develop cognitive reappraisal. Individuals first learn what the display rules are and then go through a process of understanding their value or why they make sense, until finally they adopt the norm as their own point of view. Hospitals could also benefit from the positive consequences of emotional display rules. For example, nurses could establish a good relationship with patients and consequently be satisfied for pleasure motivations.

Limitations and Further Perspectives

There are some limitations to this study. The selected design was cross sectional therefore, statements of causal relationships cannot be made. Although there is strong evidence connecting explicitness of display rule, internalization of rules with work engagement and job satisfaction, longitudinal studies are needed. Moreover, our research tests the individual-level perceptions of explicitness of display rule. It seems important to move beyond the individual level to explore the group or unit level in order to examine explicitness of display rule as shared beliefs [2]. Finally, our research was carried out on Belgian nurses. It could represent a very specific situation and any generalization of our results must be regarded with caution. Given that emotional display rules are specific to professional context Cheshin [13] and are influenced by national culture, we recommend that future studies be carried out to better understand the role played by culture and professional context on explicitness of display rule.

Conclusions

Our research indicates that the explicitness of emotional display rules has a positive relationship impact with nurses’s well-being. Emotional display rules influence nurses’s well-being through emotional rules internalization. Therefore, it is recommended that health care managers communicate the emotional display rules in a way that values professional mission and moral commitments, as to promote the internalization of norms, which, in turn, can significantly boost nurses’ engagement and satisfaction in providing care [5].

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Citation: Pohl S, Libbrecht J, Doudy-Michez O, Santo LD. Exploring the Relationship Between the Explicitness of Emotional Display Rules and Well-Being among Nurses: The Mediating Influence of Rules’ Internalization. Ann Nurs Res Pract. 2024; 9(1): 1062.

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