EMOTIONAL LABOR AND IT’S A SSOCIATED FACTORS AMONG NURSES: A CROSS- SECTIONAL AT THE NATIONAL HOSPITAL OF ENDOCRINOLOGY IN 2025

ABSTRACT

Objective: To describe the status of emotional labor among nurses and analyze related factors at the National Endocrinology Hospital in 2025.

Methods: A cross-sectional descriptive study was conducted on 356 clinical nurses from April 2025 to June 2025. The Emotional labor Scale for Nurses (ELS-N) was used to assess nurses’ emotional labor. Data were analyzed using SPSS 26.0 software.

Results: The overall mean score of emotional labor was 4.39 ± 0.62, indicating a high and stable level of implementation among nurses. The dimension “Surface Acting” scored the highest at 4.41 ± 0.64, while “Deep Acting, focusing on patients” scored slightly lower at 4.36 ± 0.66. Age, professional qualifications, income, work seniority, work position, and job title were significantly associated with the level of emotional labor (p < 0.05). Gender, marital status, and type of employment were not statistically significant (p > 0.05).

Conclusion: It is necessary to enhance psychological support, stress management, and training in emotional regulation skills for nurses, while improving the working environment and incentive policies. Nurses should actively develop communication skills, emotion control, and professional competence. Researchers are encouraged to expand studies and develop intervention models to improve emotional labor effectiveness in hospitals.

Keywords: emotional labor; nurses; emotional regulation; surface acting; occupational factors; nursing practice

I. INTRODUCTION

Emotional labor (EL) refers to the process by which nurses regulate and express emotions in accordance with professional expectations during patient care (Grandey, 2019). It is a core component of interpersonal communication in healthcare and has a direct impact on the quality of nursing services and patient satisfaction [1], [9]. In the context of increasing workload and occupational pressure in tertiary hospitals, particularly at the National Hospital of Endocrinology—where many patients with chronic conditions experience prolonged anxiety and psychological stress—nurses are required to simultaneously ensure clinical competence and provide emotional support. This dual demand necessitates continuous emotional regulation to maintain professional attitudes and effective interactions with patients. In Vietnam in general, and at the National Hospital of Endocrinology in particular, research on nurses’ emotional labor remains limited, despite its critical role in nursing workforce management and quality improvement of patient care. Therefore, this study was conducted to describe the status of emotional labor among nurses and to analyze associated factors at the National Hospital of Endocrinology in 2025.

II. METHODS

2.1. Study Design

This study employed a cross-sectional descriptive design.

2.2. Study Setting and Period

The study was conducted from March 2025 to June 2025 at the National Hospital of Endocrinology, Vietnam.

2.3. Study Participants

Inclusion criteria: Registered nurses who were either permanently employed or working under labor contracts and had been directly involved in clinical care at the hospital for at least one year were eligible for inclusion. Participants were required to be present during the data collection period and to voluntarily agree to participate in the study.

Exclusion criteria: Nurses who were absent during the data collection period due to reasons such as annual leave, maternity leave, sick leave, full-time training, or those in the process of resignation or retirement were excluded from the study.

2.4. Sample Size and Sampling Method

Sample size calculation

The sample size was calculated using the following formula:

n=Z1-α/22×p(1-p)d2
Where: n is the required sample size; Z1-α/2 is the standard normal value corresponding to a 95% confidence level (Z = 1.96);  α is the level of statistical significance; d is the margin of error, set at 5% (d = 0.05); p is the estimated proportion of nurses with a high level of emotional labor.

Based on the findings of a previous study conducted in China by Li Zhou and colleagues (2025), which reported that 70.3% of clinical nurses exhibited a high level of emotional labor [3], the value of p was set at 0.70. Applying the formula yielded a minimum required sample size of 323 nurses.

Sampling method: The hospital had a total of 370 clinical nurses. Given the relatively small population size, a census sampling approach was applied to enhance representativeness and reliability. All eligible nurses were invited to participate in the survey. A total of 356 valid questionnaires were collected and included in the final analysis.

2.5. Research Instruments

The questionnaire consisted of two main parts:

Part 1, Sociodemographic and occupational characteristics: This section collected information on participants’ age, gender, marital status, type of employment, educational level, years of professional experience, monthly income, job position, and managerial role.

Part 2, Emotional labor measurement: Emotional labor was assessed using the Emotional Labor Scale for Nurses (ELS-N) developed by J. Hong and O. Kim in 2019 in South Korea [8]. The scale consists of 16 items across three dimensions: Professional emotional regulation effort (5 items), Emotional suppression focused on patients (6 items), and Surface acting according to professional norms (5 items). The ELS-N demonstrated good internal consistency, with Cronbach’s alpha coefficient of 0.81. All items were rated on a 5-point Likert scale ranging from 1 = strongly disagree → 5 = strongly agree. Mean scores of emotional labor were interpreted using the following categories: very low (1.00–1.80), low (1.81–2.60), moderate (2.61–3.40), high (3.41–4.20), and very high (4.21–5.00).

2.6. Data Collection and Statistical Analysis

Collected data were checked for completeness and validity, coded, and entered SPSS version 26.0 for analysis. Invalid or incomplete questionnaires were excluded. Categorical variables were summarized using frequencies and percentages, while continuous variables were presented as means and standard deviations. The internal consistency of the scale was assessed using Cronbach’s alpha. Associations between emotional labor and related factors were analyzed using independent t-tests and one-way analysis of variance (ANOVA). A p-value of less than 0.05 was considered statistically significant.

2.7. Ethical Considerations

The study was conducted in accordance with ethical principles for research involving human participants. Informed consent was obtained from all participants prior to data collection, confidentiality and anonymity were strictly maintained. The study protocol was reviewed and approved by the Decision No1500/QĐ-BVNTTW dated December 24, 2025 of the Ethics Committee of the National Hospital of Endocrinology.

3. RESULTS

3.1. Characteristics of study participants

Table 3.1. Socio-economic characteristics of the study participants (n = 356)

Comments: Among the 356 nurses included in the study, the majority were female (78.7%) and aged between 31 and 40 years (66.6%). Most participants held a college-level nursing qualification (61.3%), followed by a bachelor’s degree (30.6%). More than half of the nurses had over 10 years of work experience (62.1%), and the predominant monthly income ranged from 11 to 20 million VND (77.5%). Most participants were contract-based employees (90.4%) and worked in medical wards (63.2%). Staff nurses accounted for the largest proportion of the sample (93.5%).

3.2. Status of emotional labor among study participants

Table 3.2. Descriptive results of emotional labor among nurses

Comments: The overall mean score of emotional labor was 4.39 ± 0.62, indicating a high and consistent level of emotional labor performance among nurses. The surface acting dimension showed the highest mean score (4.41 ± 0.64), reflecting a high degree of professionalism in emotional expression. In contrast, emotion regulation focused on patient care demonstrated a slightly lower mean score (4.36 ± 0.66), suggesting that personal emotions may still be affected in high-pressure situations.

Table 3.3. Associations between participants’ general characteristics and nurses’ emotional labor

Comments: The study results indicate that nurses’ emotional labor was significantly associated with age, educational level, income, years of work experience, work unit, and job position (p < 0.05). Nurses who were older had higher educational attainment, higher income, longer work experience, and held managerial positions demonstrated higher levels of emotional labor. In contrast, gender, marital status, and employment type showed no statistically significant differences in emotional labor (p > 0.05).

4. DISCUSSION

The findings of this study indicate that the overall level of emotional labor (EL) among nurses at the National Hospital of Endocrinology was high, with a mean score of 4.39 ± 0.62. This result reflects a relatively stable and effective practice of emotional labor strategies during daily nursing care. In the context of a specialized endocrine hospital, where patients predominantly suffer from chronic conditions requiring long-term treatment and frequent interactions with healthcare professionals, the ability to regulate emotional expressions in accordance with professional norms plays a critical role. Effective emotional labor contributes to the establishment of positive nurse–patient relationships, enhances patients’ sense of security, and ultimately improves patient satisfaction and quality of care.

These findings are consistent with previous studies by Grandey (2019), Xu and Fan (2023), and Lee et al. (2020), which emphasized emotional labor as a core component of nursing practice that supports professional image, strengthens patient trust, and ensures high-quality care delivery[1] [9] [7]. The high EL score observed in this study suggests that nurses have developed emotional labor practices that meet professional demands, particularly in high-pressure environments characterized by heavy workloads, time constraints, and continuous emotional interactions with patients.

When examining specific dimensions of emotional labor, surface acting demonstrated the highest mean score (4.41 ± 0.66). This finding indicates that nurses frequently modify their outward emotional expressions to conform to professional display rules, even when their genuine emotions may not fully align with expected behaviors. This result aligns with the findings of Zhou and Xiong (2025), who identified surface acting as a commonly adopted emotional labor strategy in healthcare settings, enabling healthcare workers to maintain a calm, friendly, and trustworthy demeanor in front of patients [4]. In nursing practice, particularly in chronic care settings, controlling emotional expressions is often regarded as a professional requirement to promote patient reassurance and cooperation during treatment.

However, international literature has consistently reported that prolonged reliance on surface acting, when not accompanied by adequate organizational and psychological support, may increase emotional strain and elevate the risk of occupational burnout. Therefore, the high level of surface acting observed in this study reflects not only nurses’ professionalism but also highlights the need for hospital managers to implement supportive strategies that mitigate the potential negative consequences associated with sustained surface acting.

The dimensional emotion regulation focused on patient care showed a slightly lower mean score (4.36 ± 0.64) compared to surface acting, suggesting that although nurses consciously suppress personal emotions to prioritize patients’ needs, they may still experience emotional challenges in highly stressful or demanding situations. This finding is consistent with Yalçın et al. (2025), who reported that inadequately managed negative emotions could adversely affect nurses’ job performance, quality of care, and mental well-being [2]. The relatively lower score of this dimension underscores the importance of targeted training and psychological support programs aimed at strengthening nurses’ emotion regulation capacities, particularly in complex communication scenarios and during periods of increased workload.

Importantly, this study identified several factors that were significantly associated with emotional labor. Age, educational level, income, years of work experience, working unit, and job position were all significantly related to EL (p < 0.05), whereas gender, marital status, and employment type were not associated with statistically significant differences (p > 0.05). These findings are consistent with previous studies by Lee et al. (2021) and Kim et al. (2020), which highlighted the central role of professional characteristics and work experience in shaping nurses’ emotional labor practices [7] [5].

Nurses with longer work experience and higher educational attainment tended to demonstrate higher levels of emotional labor, possibly due to their accumulated exposure to complex interpersonal situations and sustained occupational pressures over time. Similarly, Zhang et al. (2025) reported that years of experience and job position were key determinants of emotional labor, as they are closely linked to professional autonomy, decision-making capacity, and perceived control over work processes [10]. These findings suggest that emotional labor should be understood not merely as an individual capability, but as a phenomenon strongly influenced by organizational context and working conditions.

Income level and job position were also identified as important factors associated with emotional labor. This result is in line with Chen et al. (2025), who demonstrated that an imbalance between effort and reward, combined with high emotional labor demands, could negatively affect nurses’ physical and psychological health [3]. Conversely, adequate organizational support, fair compensation, and opportunities for professional development may buffer the adverse effects of emotional labor and help nurses maintain positive emotional states at work. These findings emphasize the critical role of human resource management policies in enhancing effective emotional labor practices within hospital settings.

The absence of significant differences in emotional labor according to gender and marital status is consistent with the findings of Zhang et al. (2019), who suggested that in highly standardized public hospital environments, professional requirements and organizational norms tend to override demographic differences [10]. This observation further supports the notion that emotional labor in nursing is primarily shaped by occupational and organizational factors rather than individual demographic characteristics alone.

Taken together, the results of this study suggest that enhancing nurses’ emotional labor capacity requires a comprehensive approach. Such an approach should include emotion regulation training tailored to nurses’ age, educational level, and job position, as well as improvements in the working environment, increased psychological support, adequate income, and clear career development pathways. These interventions may not only reduce the risk of occupational burnout but also contribute to improved quality of care and greater patient satisfaction in contemporary healthcare settings.

Several limitations of this study should be acknowledged. First, the study was conducted at a single specialized hospital over a relatively short period, which may limit the generalizability of the findings to other healthcare settings. Second, the use of self-reported measures may have introduced information bias due to social desirability. Finally, other psychosocial factors that may influence emotional labor were not fully examined. Future studies should consider multi-center designs, mixed-method approaches, or longitudinal frameworks to provide a more comprehensive understanding of emotional labor dynamics and their long-term effects on nurses’ mental health and professional outcomes.

5. CONCLUSIONS AND RECOMMENDATIONS

This study found that nurses’ emotional labor was at a high level, indicating a strong ability to maintain professional conduct in patient care, with surface acting being the most frequently used strategy and emotion regulation focused on patient care relatively lower. Emotional labor was significantly associated with professional factors, including age, education, income, years of experience, working unit, and job position, while demographic characteristics showed no significant differences. These findings underscore the central role of organizational context and professional experience in shaping nurses’ emotional labor. Hospitals should prioritize targeted training and psychological support to enhance emotion regulation capacities, particularly for younger and less experienced nurses in high-intensity care settings. Emotional labor competencies should be integrated into continuing education, performance evaluation, and nursing workforce management. Future research should employ longitudinal designs and multi-site samples to examine the long-term effects of emotional labor on care quality and nurses’ professional development.

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Dinh Thi Luot¹, Ngo Thi Thuy Duong¹

National Endocrinology Hospital

Coresponding author: Dinh Thi Luot, email: dinhluotbvn@gmail.com   Số điện thoại: 0966125361