The Social Context of Caregiving Work in Health Care: Pushing Conceptual and Methodological Frontiers

Abstract

As the demands and nature of caregiving work in the health-care sector become more varied and challenging, our research and theories need to match this evolving reality. This editorial introduces theories of caregiving work and then uses each of the four papers featured in the special issue to advance a more nuanced and social approach to theorizing and studying the emotional experience of caregiving work. The articles and editorial explore the implications of whole person organizational and social supports, (un)shared social location between caregivers and patients, the complexity and consequences of emotional experience, and novel measurement and analytic tools to study them.

Keywords

care work caregiving emotional experience emotional labor health care

It is well established that service work—particularly in health services—is cognitively, emotionally, and physically demanding (e.g., Bakker & Demerouti, 2007; Subramony et al., 2017). Specifically, caregivers are vulnerable to potentially traumatic adverse incidents that can result in serious harm to or death of patients (Wu, 2000). In fact, medical practitioners are considered second victims in incidents that harm patients (Dekker, 2013; Wu, 2000). As such, health-care work requires continuous high levels of caring and vigilance to manage the high stakes surrounding patient care (i.e., loss of life, extreme patient vulnerability, Vogus et al., 2010), in addition to maintaining the well-being of family members tied to the patients (e.g., Pochard et al., 2001). Caregiving work is also emotionally demanding, as it inherently puts caregivers in direct contact with human suffering and requires caregivers to regulate their own emotions, as well as the emotions of others (e.g., patients, patients’ family members; Grandey & Gabriel, 2015). And the physical demands of caregiving work—from handling difficult patients and family members (e.g., Gilardi et al., 2019) to working long shifts without breaks—can also take a dramatic toll on the well-being and health of care providers.

Indeed, the combination of high levels of cognitive, emotional, and physical demands, paired with high-stakes consequences associated with the work being done, has the potential to deplete the psychological and emotional resources of caregivers, thereby culminating in emotional exhaustion (Bakker & Demerouti, 2007) and states of affective ill-being (Gabriel et al., 2011). Consequently, caregivers report among the highest levels of burnout and job dissatisfaction of any professional group (Dyrbye & Shanafelt, 2016), with conservative estimates suggesting that at least half of physicians, nurses, and administrators report burnout from and dissatisfaction with their jobs (Shanafelt et al., 2015). But this number may be higher as two separate studies revealed that between 80% and 87% of nurses studied exhibited symptoms of burnout (Mealer et al., 2009, 2012). Importantly, the prevalence of burnout and ill-being among providers is consequential for patients, as experiences of burnout are associated with worse patient outcomes (e.g., decreased patient satisfaction/quality of compassionate care, greater incidence of medical error; Aiken et al., 2002; Dzau et al., 2018; McClelland et al., 2018; Trzeciak & Mazzarelli, 2019). Moreover, the epidemic of burnout is also contributing to concerns over a future shortage of care providers, as burnout and fatigue has been contributing to an exodus from the health-care industry (e.g., Kalisch et al., 2010). It is therefore not surprising that the National Academy of Medicine (2017) in the United States has launched an action collaborative in an effort to promote and support clinician well-being and resilience.

Combined with the various and increasing demands caregivers, it is necessary to take steps to advance scholarship focused primarily on the health and well-being of the providers themselves. Thus, in this special issue, we focus explicitly on the emotional experience of caregiving work, with an emphasis on helping better understand the factors that contribute to caregiver emotional exhaustion and well-being at work. Interestingly, the emotional experience of caregiving work has typically been understood using emotional labor (Hochschild, 1983), service triangle (Leidner, 1993, 1996), and job demands (Bakker & Demerouti, 2007) perspectives. Hochschild (1983) first introduced the concept of emotional labor—the effort of aligning emotional displays with managerially imposed organizational display rules—and it has become a cornerstone of the sociology and psychology of service work (e.g., Diefendorff et al., 2011; Grandey & Gabriel, 2015). The service triangle helps understand service work generally, and caregiving specifically, as a three-way interest alliance among managers, workers, and customers (Leidner, 1993, 1996). In addition to articulating conditions under which the interests are in conflict, service triangle theory and research reframes management control as a potential resource for workers as they engage with customers as well as customers as a resource in conflicts with managers (Rosenthal, 2004). Finally, and as previously detailed, the job demands perspective helps classify the various demands employees may be exposed to at work, outlining possible resources that may help cope with such demands (e.g., Bakker & Demerouti, 2007; Bakker & Sanz-Vergel, 2013).

The articles comprising the special issue advance and challenge these leading perspectives and often do so in tandem with considering the changing reality and increasing complexity and pressures of health-care work. Chang et al. (2020) focus on a pervasive issue for caregivers—musculoskeletal disorders (MSDs). They find in a study of 410 nurses in 29 units that such injuries are grounded in their emotional experience and support. Specifically, when nurses reported higher support exchange imbalance (i.e., giving more support than they received), they experienced more anger, which was associated with more severe MSD symptoms. This relation was exacerbated when nurses perceived that a similar level of support was available to others within their unit. Using audio diary data from 48 acute care hospital nurses, Cottingham and Erickson (2019) develop and deploy an emotion practice approach to significantly extend the emotional labor perspective. They do so by capturing complex, embodied emotional experiences of care providers and powerfully depicting how shared social position affects how and for whom emotional resources are provided. Amid the growing burnout and dissatisfaction among caregivers, Lee et al. (2019) counterintuitively find that job dissatisfaction is positively associated with generating quality improvement ideas in 12 clinics. They posit this occurs in the context of meaningful work and find the relationship between dissatisfaction and creativity is stronger for individuals with shorter tenure, in central (caregiving) roles, and when engaged in more boundary spanning. Finally, Kossek et al. (2019) examine the work of an underappreciated set of workers in care delivery—job schedulers. In a rich qualitative study, they detail how nursing home functioning relies on the ability of schedulers to engage in various forms of patching (i.e., ongoing adjustments to address holes in scheduling) that takes the unique needs of employers, employees, and patients into consideration. Exploratory analysis linked improvising schedules to address work–life issues and fewer pressure ulcers.

The remainder of this editorial explores the ways in which these articles force us to rethink core theories and methods for understanding the emotional experience of caregiving work and point to a new research agenda. Specifically, we illustrate how roles, systems, and interventions (a) help better understand the caregiver as a whole person, (b) explicate the emotional experience and consequences of (un)shared social location between caregivers and patients, (c) provide a holistic understanding of the complexity of emotional experience, and (d) suggest the need for novel measurement and analytic tools to study the emotional experience of caregivers.

Whole Person Organizational and Social Supports

All the papers in the special issue speak to the value of practices and supports (and the costs of their absence) for the whole person delivering care. This involves support that helps in managing not only the cognitive, emotional, and physical demands of the work but also the broader life demands that inform one’s emotional experience at work. Each of these papers speaks to these issues in ways that advance and challenge core theories (e.g., emotional labor, service triangle) and suggests promising and provocative directions for future research.

In her formulation of the service triangle, Leidner (1993) reframed the customer (i.e., patient) as a potential ally of workers. Kossek et al.’s (2019) research suggests one way that patients can be allies to employees—providing a legitimate rationale for caregiving continuity. This could enhance the emotional experience of caregiving work as caregivers develop deeper relationships with their patients. Deeper relationships, with their attendant more nuanced and particular understanding of patient needs, suggest that the care will be more tailored and higher quality as a result (Benner et al., 1996). Future research could use newer settings intending to deliver more patient-centered care (e.g., patient-centered medical homes; Avgar et al., 2011) to explore whether these forms alter the service triangle in ways that deepen the alliance between caregivers and improve meaningfulness and caregiver well-being at work.

The articles in the special issue also force us to rethink relations within each side of the service triangle. The service triangle identifies the impact of relationships between patients, employees, and managers, but each group also exhibits complex relationships among coworkers, for example. Few studies of the service triangle have considered these horizontal relations (Lopez, 2010, p. 254), but see Subramanian and Suquet (2018) for a notable exception. In what ways is the service triangle altered when collectives are delivering care (which is increasingly the case in health care)? Moreover, does team-based care provide coping or introduce new emotional demands that exacerbate the occurrence of, for example, burnout? Lee et al. (2019) suggest that teams are an effective vehicle for resiliently coping with demands by channeling dissatisfaction to constructive aims (e.g., quality improvement). Future research should aim to thoroughly understand the consequences of relationships and structures among components of the service triangle (e.g., care provider teams) or structures that reconfigure relationships among, for example, care providers and patients (e.g., patient and family advisory councils).

Kossek et al.’s (2019) research on job schedulers also broadens the service triangle as it speaks to a category of health-care professionals that are typically ignored in research on the emotional experience of caregiving work—coordinators. Coordinators, navigators, schedulers, and other new roles set how interactions among administrators, caregivers, and patients occur. In doing so, they consider the broader personal and professional factors (i.e., the whole person) in a way that directly and indirectly influence employee emotional experience. Directly, they determine whether and how an individual’s scheduling needs are met. This is observed, for instance, when schedulers plan for or improvise responses that account for work–life demands (Kossek et al., 2019). Meeting an individual’s scheduling needs also affects both the individual making a request and those working with them (i.e., are they able to work with individuals with whom they have prior experience, good relationships, etc.?).

Indirectly, their work also has implications for how smooth (or not) the care delivery system may operate based on the composition of caregivers working at a given time. The job scheduler role is akin to a growing number of roles focused on clinical coordination and otherwise smoothing communication and coordination across organizational and occupational boundaries as well as making care delivery more patient-centered (Vogus & Singer, 2016). Many of these roles accompany efforts to integrate inpatient and other sites (e.g., outpatient, long-term care) of care delivery as in the case of new organizational forms such as Accountable Care Organizations in the United States (Vogus & Singer, 2016). In addition, job schedulers and the rules they enforce help set the terms between administrators and caregivers regarding who delivers care and when they do so. As such, coordinators, schedulers, and related roles may play a crucial role in determining the extent to which a set of relations among managers, caregivers, and patients produces or hinders high performance (e.g., low cost, high quality, and positive health outcomes) for both patients and caregivers. There is suggestive evidence from New York Presbyterian’s regional health collaborative supporting the importance of these roles for effectiveness. Specifically, nurse care managers proactively identify high-risk patients from electronic disease registries and previsit planning teams anticipate what screenings, referrals, and educational activities will be necessary to reduce costly emergency department visits and hospitalizations (Carrillo et al., 2014). Other organizations as diverse as the Hennepin Health safety net Accountable Care Organization and University Hospital in Cleveland have similarly deployed care coordinators and navigators to anticipate threats to cost and quality (Sandberg et al., 2014). Kossek et al. (2019) also richly describe how schedulers not only anticipate but also respond through processes of patching and improvisation that build resources (e.g., problem-solving capabilities, relationships) for absorbing future disruptions and preserving care quality and safety (e.g., fewer pressure ulcers). Future research should more directly and fully explore the effects of these roles (and their occupants) for refining the service triangle theoretically as well as how and under what conditions a given set of relations affect patient experience and clinical performance outcomes.

In describing his research on nursing homes, Lopez (2006) details, consistent with Cottingham and Erickson (2019), how emotional labor does not tell the whole story of emotional experience. Specifically, Lopez (2010, p. 254) details evidence of managerial and organizational support for emotional authenticity and positive relationship building that led him to conclude that “emotional labor was not the only way that organizations could manage emotion … organized emotional care” (p. 254). That is, positive managerial support for emotional authenticity and relationship building through rules and procedures are oriented toward supporting relationships without imposing feeling rules (Lopez, 2006). In a recent study of a community hospice care program, DiCicco-Bloom and DiCicco-Bloom (2019) found that when leaders support discussing and processing emotional labor in interdisciplinary meetings, it improves both care quality as well as employee experience of the care they deliver and the emotional labor in which they engage. Chang et al. (2020) and Kossek et al. (2019) similarly demonstrate the importance of organizational and managerial support to employee emotional experience, highlighting the importance of balance and adaptability.

Organized emotional care also suggests the importance of investigating organizational design and leader interventions to shape emotional supportiveness with (potentially) positive consequences for patients and workers. One such approach would be injecting organizational compassion—empathic understanding of particular suffering and the desire to address it (Cleary, 2016). For instance, implementing organizational compassion practices that recognize and reward compassionate acts and support processing workplace trauma have been associated with higher nurse psychological vitality and lower emotional exhaustion (McClelland et al., 2018), presumably because they provide customized responses to suffering (Benner et al., 1996) and create meaning for nurses (Wrzesniewski & Dutton, 2001). When leaders role model and legitimate compassionate responses to suffering, similar benefits are observed (Barsade & O’Neill, 2014). Compassion practices have also been associated with better patient experience ratings (McClelland & Vogus, 2014). This raises interesting questions regarding why this might emerge—does compassion produce patient-centered, whole person care (Anhang Price et al., 2014)? Can elevating compassion as an organizational value overcome some of the emergent disparities documented by Cottingham and Erickson (2019) like withholding of emotional and other forms of assistance for demographically dissimilar caregivers and patients? Overall, considering organized emotional care has implications for the service triangle, specifically, (how) do compassion practices and leader compassionate acts influence the quality of the relationships between patients, caregivers, and managers? How does that configuration of relationships affect employee, organizational, and patient outcomes?

(Un)Shared Social Location and Emotional Experience

Researchers of emotional labor have long appreciated the role of display rules as the primary means through which organizations shape individuals’ outward emotional expressions (Hochschild, 1983). But there has been comparatively little research examining the role that shared social location—social class, race, and/or gender—may have on one’s emotional attunement and expression to others. In other words, social location defines who is one of our kind and, therefore, deserving (McPherson et al., 2001). Cottingham and Erickson (2019) sharply illustrate through powerful caregiver narratives the profound, yet often subconscious, role of shared social location has on whose emotions are absorbed and the emotional and behavioral responses that follow. Specifically, they document how emotional bonds and a high degree of compassion results for demographically similar patients. In contrast, less racially or socioeconomically similar patients are viewed with skepticism (i.e., as users of the system who take all those things). Consequently, caregivers may form less of an emotional bond and withhold emotional resources (e.g., caring) from demographically dissimilar patients. Through their findings, Cottingham and Erickson (2019) return to the emotional labor literature to the pragmatist and structural roots of Hochschild’s (1983) foundational work.

Prior research has not extensively explored the affective and relational mechanisms through which demographic dissimilarity between caregivers and patients produce disparities in care as well as poor care experience and outcomes. However, based on Cottingham and Erickson’s (2019) findings, this is an area in need of further research. Shared social location is posited to shape whose emotions we readily notice, identify with, and respond to as well as those which seem unfamiliar and require more effort to do so. Thus, shared social location may affect health outcomes and patient experience through enhancing personalized, tailored care and enabling a stronger therapeutic relationship (Benner et al., 1996).

Cottingham and Erickson (2019) also offer a factor that may serve as a potential moderator on these relationships—emotional capital. Drawing on prior work, they define emotional capital as the emotion-based knowledge, management skills, capacities, resources, and energy that individuals calibrate as they move from one interaction to another and navigate ongoing social demands (Cottingham, 2016; Erickson & Cottingham, 2014). Future research could build on this work to measure emotional capital and assess the extent to which individuals with greater emotional capital may be able to navigate multiple dimensions of demographic dissimilarity (e.g., socioeconomic status, race, gender, culture) and deliver high-quality, emotionally attuned care and feel less exhausted from it. For example, given the importance of shared social position to emotional connection and deploying emotional capital (Cottingham & Erickson, 2019), do organizations that are better able to match the demography (gender, race, or social status) of their caregivers to their patients receive better patient experience ratings? In the absence of being able to hire for demographic similarity, does a supportive organizational climate that values diversity (e.g., McKay et al., 2007) positively affect patient experiences? In addition, based on prior research, matching community demography may enhance the value for patient experiences of diversity-oriented organizational practices and processes including diversity climate (Brief et al., 2005). In addition to its effects on patient emotional experience and care quality, do factors such as diversity climate or emotional capital also influence employee burnout? Does it depend upon the overall demographic composition of the organization (e.g., Pugh et al., 2008)? Are there organizational initiatives or practices that rethink how organizations enact, for example, gender (Ely & Meyerson, 2010) that foster meaning and reduce burnout? All of these questions jointly suggest the value for building on Cottingham and Erickson (2019).

The Complexity and Consequences of Emotional Experience in Caregiving Work

The papers in the special issue offer a sophisticated rendering of emotional experience and its consequences. Specifically, they depict emotion as embodied (Chang et al., 2020; Cottingham & Erickson, 2019), complex (Cottingham & Erickson, 2019), and nonobviously consequential (Lee et al., 2019). They also point toward conditions under which emotions become shared and collective (Cottingham & Erickson, 2019; Lee et al., 2020).

Patient care work is both emotionally and physically constituted (Hochschild, 1983). In other words, emotional experience and physical sensation are intertwined. At its most basic level, as Chang et al. convincingly demonstrate, the experience of a discrete emotion—anger—has physical consequences (e.g., low-back pain, upper limb pain, and upper body pain). Emotions such as anger likely trigger stronger body awareness (Sauter & Swanson, 1996) with the subsequent discomfort increasing the recognition and reporting of MSDs (Menzel, 2007). More precisely, anger has been linked to a lower pain tolerance (van Middendorp et al., 2010) and higher pain reports (Janssen et al., 2001). Cottingham and Erickson (2019) qualitatively document co-occurring experiences of a range discrete emotions and physical consequences (e.g., headaches). Continuing to expand the exploration of discrete emotions (e.g., anxiety, contempt, frustration) and their physiological consequences for caregivers and the care their patients receive remains a worthwhile pursuit for future research.

Chang et al. (2020) also theorize and document how support and most importantly the perceived (mis)match in support (i.e., relative amounts given to received) puts caregiver bodies at risk of injury. Perceived imbalance of support exchanges means individuals are more likely to feel isolated, and the effects of perceived imbalance were exacerbated when there was consensus on a caregiving unit regarding the amount of support available. That is, feeling negatively distinctive in this way heightened feelings of anger and resulting injury. Critically, perceptions of imbalance and anger might be especially likely to generate injuries in caregiving work because caregivers view their work as a calling, rooted in the philosophical origins of health care as a healing profession (Dyrbye & Shanafelt, 2016). Prior work in nursing illustrates how caregivers who view their work as a calling are especially likely to experience bodily injury because they view self-sacrifice (i.e., bodily sacrifice) in service of the patient as an indication of commitment to the patient, especially when they feel undersupported (Gordon, 2005). Future research could test the extent to which caregivers view their work as a calling (Wrzesniewski et al., 1997) or otherwise highly identify with their profession (Meyer et al., 1993) is linked to injury rates. Other antecedents also merit investigation, including leadership that is highly supportive of and focused on safety (Eatough et al., 2012) and caregiver workload (e.g., staffing levels; Gordon et al., 2008).

Emotion can also be experienced in more complex ways (i.e., ambivalently; Rothman et al., 2017). Cottingham and Erickson (2019) describe rapid oscillation between anger and sadness toward the same target (e.g., a temporary colleague) or across the course of the day. Their research helpfully depicts the multiplicity of emotions that unfold in response to complex events and dynamic workplaces. Future research can build on the rich descriptions of these varied emotional experience to examine the characteristics of individuals and their work contexts that enable holding multiple emotions simultaneously or effectively toggling emotions rapidly and potential benefits of doing so (e.g., holistic information processing; Rees et al., 2013). Cottingham and Erickson (2019) also point to the power of collective emotions and mood in shaping the cognition and behavior of the nurses they study. Future research should build on their work as well as recent theoretical work on affect climate (e.g., Parke & Seo, 2017) to examine the ways in which such climate emerges, spreads, and influences interpersonal and organizational processes and outcomes.

Finally, Lee et al. (2019) serve as a valuable counterweight to the evidence linking negative emotions to negative outcomes by demonstrating the upside of negative emotion. Specifically, they find job dissatisfaction is positively associated with creative ideas for quality improvement, with these effects amplified when the dissatisfied are shorter tenured, have greater clarity about their role, and better connected (i.e., have more connections to members of other teams). The context in which these provocative findings are observed—quality improvement teams—suggests possible implications for redirecting negative emotion to obtain beneficial outcomes. Quality improvement teams signal a positive future is possible, and, consequently, the work being pursued is likely to be engaging and meaningful, which can spark effort and persistence needed to generate and implement ideas (Grant & Berry, 2011). In other words, quality improvement teams provide a context and a mission for constructively channeling dissatisfaction. It would also be worth systematically examining other modalities such as hackathons or other care co-design initiatives that bring together leaders, patients and families, and workers (Institute of Medicine, 2012) as means of redirecting dissatisfaction (and dissatisfied individuals) toward creative and improvement-oriented action. Korczynski (2003) suggests an additional possibility for why dissatisfied individuals may be associated with creativity in improvement teams—the teams serve as communities of coping that allow individuals to turn to one another to deal with the pain inflicted by broken systems, irate patients, and poor outcomes. Future research should explore communities of coping as a resource to positively channel felt negative emotions at work.

Methodological Considerations for Future Research

Several methodologies were used across the studies in the special issue, spanning multilevel considerations (i.e., nurses nested within units; Chang et al., 2020), qualitative interviews that led to the development of new typologies and/or frameworks (Cottingham & Erickson, 2019; Kossek et al., 2019), and objective sources of information to inform the social context of caregiving work (i.e., sociometric sensors; Lee et al., 2019). The variety of methods used highlights that much is still to be learned surrounding the social context of health care, with novel methods providing much needed empirical and theoretical insight. Based on our views into the evolving nature of health-care contexts, we see value in two methodological approaches that can help guide future research beyond the methods exemplified by the special issue authors.

First, several aspects of caregiving in health care are contingent upon day-to-day events and fluctuations in well-being (e.g., event-to-event and day-to-day fluctuations in affective states, emotional exhaustion, and somatic indicators) and performance (e.g., satisfaction with direct and indirect patient-focused care, medication errors). Such ideas relate to the episodic nature of work, in that affective states, cognitions, and behaviors may vary from one day to the next in response to health-care providers’ exposure to a variety of events (Beal, 2015; Beal & Gabriel, 2019; Gabriel et al., 2019). For example, in a study of nurses, Gabriel et al. (2011) found that day-to-day variations in task accomplishment satisfaction were predictive of nurses’ end-of-work shift positive and negative affect, lending important insights into how performance on tasks related to patient care influenced nurses’ subsequent well-being. Likewise, Bakker and Sanz-Vergel (2013) found that nurses’ personal resources (e.g., feelings of self-efficacy and optimism) related positively to nurses’ weekly work engagement when the emotional demands of the job were high versus when they were low. These studies are only two examples that highlight the fact that (a) aspects of health-care work vary within-person, and (b) these within-person fluctuations can lead to meaningful outcomes to help better the experience of care providers.

The question, then, is how within-person methods can be effectively used. Although a complete review is beyond the scope of this editorial (for more comprehensive detail, please see Beal, 2015; Gabriel et al., 2019; Ohly et al., 2010), we wish to make a few plausible suggestions. First, as noted by Beal and Gabriel (2019), researchers should consider using multiple within-person methods to better understand the time course of within-person phenomena. Take, for example, the effects of patient and/or patient family member mistreatment on nurses’ behavior. Given the likelihood that such negative social interactions will elicit strong affective reactions (e.g., feelings of anger, fatigue, and depression), of interest would be using within-person methods to better delineate: (a) how often such events occur (e.g., using an event-contingent within-person design where employees complete surveys when such negative interactions occur) across a work shift over several days; (b) how long these events render downstream consequences (e.g., assessing how long a negative interpersonal episode affects providers’ daily well-being and performance through a series of lagged effects within and across days; Wang et al., 2013); (c) whether stable aspects of the social context—such as collegial nurse–physician relations (e.g., Gabriel et al., 2011, 2013) or compassion practices (e.g., McClelland & Vogus, 2014)—attenuate or enhance reactions to mistreatment from patients and their families; and/or (d) identifying whether stable aspects of the self (e.g., identification with the health-care provider role, Thoits, 2013; trait mindfulness, Glomb et al., 2011) have similar buffering or enhancing effects. Similar questions could be asked for how daily acts of enacted compassion toward others or receipt of gratitude render benefits for care providers (e.g., Spence et al., 2014). By considering within-person variation in caregivers’ experiences as meaningful variance (vs. error in measurement; Dalal & Hulin, 2008) that can be predicted by daily events, we can better understand the unfolding nature of caregiving work. Such methods also lend themselves well to objective markers such as sociometric badges, actigraphs (e.g., devices used to track exercise/steps), and other objective health indicators (e.g., blood pressure cuffs; Bono et al., 2013) that can be incorporated daily.

Second, the majority of work in health-care contexts—including the work highlighted earlier—has taken a variable-centered approach to understanding caregivers’ experiences both within- and between-person (e.g., Wang & Hanges, 2011). By variable-centered, we mean that scholars have examined how a set of predictors (e.g., elements of the Practice Environment Scale of the Nursing Work Index) relate to outcomes of interest (e.g., well-being) via variable-centered analyses such as regression or multilevel modeling (e.g., Gabriel et al., 2013). Although this approach is not inherently problematic, it is somewhat limiting when thinking about the holistic nature of caregivers and their work. For instance, one could consider the Practice Environment Scale of the Nursing Work Index, which encompasses caregivers’ perceptions of participation in hospital affairs, staffing adequacy, collegial nurse–physician relationships, and managerial support. A variable-centered approach would place these four constructs into a simultaneous regression, allowing researchers to glean how each dimension predicts well-being or performance above and beyond the other dimensions in the model. However, it is potentially more value from a conceptual standpoint to understand how caregivers stand holistically on all four dimensions versus understanding the unique effects of each dimension in isolation (Wang & Hanges, 2011).

This latter notion reflects a person-centered view of organizational research (Morin et al., 2011; Wang & Hanges, 2011) and represents what we would argue to be a necessary departure in how we study the social context of health care. Interestingly, both micro (i.e., individual, team) and macro (i.e., organization, field) levels of organizational research have embraced person-centered views, albeit via different methodological and analytic paradigms (for a review, see Gabriel et al., 2018). For instance, microresearchers have emphasized latent profile analysis, examining how subpopulations of employees naturally emerge within a given sample that have quantitatively and qualitatively distinct standing on a set of relevant constructs in relation to antecedents and outcomes of interest. Quantitatively distinct profiles would involve employees who report similarly high, moderate, and low levels on all constructs in the profiles (e.g., similarly high on all four dimensions of the Nursing Work Index); qualitatively distinct profiles, on the other hand, capture subpopulations that vary in shape and relative standing across profile variables (e.g., a profile comprised of low participation in hospital affairs and staffing adequacy paired with high managerial support and collegial nurse–physician relationships). On the macro side, researchers have adopted fuzzy set qualitative comparative analysis to examine how configurations of predictors emerge in the relation to an outcome. Unlike latent profile analysis, fuzzy set qualitative comparative analysis allows certain constructs to drop out, meaning researchers can gain insight into which configurations are necessary to obtain an outcome. Importantly, both approaches are inductive, meaning that these methods are not just empirically interesting but also have the potential to shape and develop theory.

Conclusion

In summary, the health-care industry is undergoing significant change—and, at times upheaval—with wide-ranging consequences for the delivery of care. Building on the four papers in this special issue, we aimed to illustrate how a more holistic, nuanced, and socially embedded characterization of emotional experience and caregiving work better captures the reality of health-care delivery and its individual and organizational consequences. These papers also provide a foundation for rethinking how we study emotional experience by using person-centered approaches. We hope this editorial and the papers in the special issue inspire more work to understand and improve the social and emotional experience of caregiving work in health care.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Timothy J. Vogus

Author Biographies

Timothy J. Vogus is the Brownlee O. Currey, Jr. professor of Management in the Owen Graduate School of Management at Vanderbilt University. His research focuses on the cultural, discursive (mindful organizing), and emotional (compassion) processes through which individuals and collectives produce highly reliably experiential, quality, and safety outcomes.

Allison S. Gabriel is an associate professor of management and organizations and Robbins fellow at the Eller College of Management at the University of Arizona. Her research focuses broadly on emotions at work, interpersonal stressors, employee recovery, and well-being, with an emphasis on within-person processes and person-centered methodologies.

Laura E. McClelland is an associate professor in the Department of Health Administration in the College of Health Professions at Virginia Commonwealth University. Her research examines workplace compassion, employee well-being, and patient experience, with a focus on how these constructs influence health care organization outcomes including the quality of patient care.

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