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The suppression of negative

emotions in elder care


Department of Psychology, University of South Florida Sarasota-Manatee,

Sarasota, Florida, USA

Jennifer Z. Gillespie
Patricia B. Barger

Received May 2010

Revised January 2011
Accepted February 2011

Kronos, Inc., Beaverton, Oregon, USA

Jennifer E. Yugo
School of Business Administration, Oakland University, Rochester,
Michigan, USA, and

Cheryl J. Conley and Lynn Ritter

Alzheimers Association, Northwest Ohio Chapter, Toledo, Ohio, USA
Purpose The purpose of this paper is to describe two studies that investigate the suppression of
negative emotions in the context of elder care, including the emotional job demands that may, together
with display rules, elicit negative suppression (Study 1) and the association between negative
suppression and job attitudes (Study 2).
Design/methodology/approach Group interviews were conducted to understand the emotional
demands of elder care (Study 1), and a survey was administered to direct care providers that included
measures of negative suppression, job satisfaction, and job stress (Study 2).
Findings Difficult events with patients (e.g. deterioration) are an emotional demand that may
interact with display rules to elicit negative suppression (Study 1). Negative suppression is generally
associated with less favorable job attitudes, controlling for individual differences in affectivity
(Study 2).
Research limitations/implications This investigation is the first both to qualitatively examine
the emotional demands of elder care (Study 1) and to empirically demonstrate links between negative
suppression 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, and
the 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

Journal of Managerial Psychology

Vol. 26 No. 7, 2011
pp. 566-583
q Emerald Group Publishing Limited
DOI 10.1108/02683941111164481

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

Long-term care for the elderly (i.e. elder care) is facing a serious supply-and-demand
problem in the USA. On the demand side, over three million Americans currently make
their home in either an assisted living community or in a nursing facility, with three
million more using home health services (American Health Care Association, 2010a).
The number of Americans over the age of 65 is increasing steadily (Administration on
Aging, 2010), and by the year 2050 it is expected that 27 million Americans will use
elder care. On the supply side, there is already a staffing shortage. The turnover rates
in 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 jobs
nationwide is only about 3 per cent (Bureau of Labor Statistics, 2010).
Previous researchers have suggested more attention be paid to the emotional labor
associated with elder care (e.g. Wharton, 2009). Care work is defined as a form of
interactive service that involves the maintenance and development of the capabilities
of others (England, 1992, 2005), in which caregivers give sustained, close, direct mental
and physical attention to the persons being cared for (James, 1992). Emotional labor
occurs when employees manage their feelings in accordance with organizationally
defined rules and guidelines (Hochschild, 1983; Wharton, 2009). There is a wealth of
research on emotional labor in prototypical customer service contexts, such as call
centers and restaurants (e.g. Barger and Grandey, 2006; Groth et al., 2009). These
employee-customer interactions are characterized by relatively brief customer
interaction and the provision of service with a smile. In contrast, elder care
relationships occur over longer periods of time (e.g. Gutek et al., 1999) and involve
managing a variety of emotions, some of them contradictory (e.g. Bolton, 2000).
Psychological theories of emotional labor posit a stimulus-response model whereby
people regulate or control an emotion that would be inappropriate to express in a given
social situation (Grandey, 2000; Gross, 1998). In this way, employees exert effort to produce
appropriate emotional displays in the face of emotional demands (e.g. difficult customers;
Goldberg and Grandey, 2007). Especially when emotional labor involves working to
suppress or conceal negative emotions, termed negative suppression, it may have serious
psychological and physical costs (e.g. Mauss and Gross, 2004). Thus, negative suppression
is important to study, as it has direct implications for employee health.
Based on the foregoing discussion, we present two studies conducted in elder care
organizations that address different parts of the emotional labor process (Grandey,
2000). Study 1 uses group interviews to better understand the emotional demands of
elder care, which together with display rules are theorized to elicit the suppression of
negative emotions. Study 2 uses survey methodology to examine the empirical
relationship between negative suppression and job attitudes, which are theoretical
outcomes of emotional labor. In the discussion, we explain the implications of these
studies for improving human resource management in elder care.
Study 1
In Study 1, we conducted group interviews to better understand the emotional
demands of elder care from the perspective of the people who actually do the work. The
job activity assisting and caring for others is high in emotional demands (Glomb
et al., 2004), yet we know relatively little about the events that comprise these ongoing
demands in the context of elder care. Thus, we wanted to better understand the kinds
of affective events or shocks that elicit felt emotion, such as anger (Weiss and

Suppression of



Cropanzano, 1996), which together with display rules may motivate employees to use
negative suppression (Grandey, 2000).
As mentioned, it is relatively common in the literature to study emotional labor in
prototypical customer service jobs, where the display rules suggest that employees
provide 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 kind
and 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 be
emotional jugglers where they express a variety of emotions, some of them
contradictory (Bolton, 2001). Part of this juggling act stems from the consensus among
caregivers that to a certain degree effective care work necessitates involvement with
the recipient of care. That is, for caregivers to remain too distanced would be looking
after 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-being
elicit negative emotions; further, it suggests that people will make efforts to manage
those emotions (Lazarus, 1975, 1999). Applied research shows that being treated
unfairly or with hostility by customers is associated with heightened efforts to regulate
or manage emotions at work, as employees exert themselves to suppress or conceal the
resulting negative emotions (Grandey et al., 2004; Rupp and Spencer, 2006; Spencer and
Rupp, 2009).
In the context of elder care, however, patient aggression is yet another possible
emotional demand. One reason for this aggression is that, unlike the prototypical
service encounter, the customers in long-term care may have dementia, as it is
experienced 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 its
behavioral and psychiatric manifestations include aggression, wandering, and
delusions (Nagaratnam et al., 1988). Related, sometimes patients exhibit acts of
aggression toward the people who care for them (Gates et al., 2005).
Thus, in the present study, we expected based on existing research that the
emotional demands of elder care may include being treated unfairly or with hostility by
residents and being subject to acts of physical aggression.
Participants and procedure. Twenty-eight employees of two elder care facilities
(nursing home and assisted living) located in the Midwestern United States
participated in one of four group interviews. Participants were asked, What are some
examples of situations in which your job as a caregiver has been demanding,
cognitively and/or emotionally? We were interested to hear about events that
illustrate the demands of elder care; thus, we encouraged them to talk concretely about
specific incidents. The first author and/or a co-author with experience in elder care
facilitated 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 research
assistants 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:


Suppression of

difficult events with patients;

work/home conflict;
patient-family stress; and
money and job concerns.

Additionally, although the present study focuses on the emotional demands of elder
care, another theme of the statements made during group interviews was desirable
aspects of the job.


The major themes from the group interviews that pertain to the emotional demands of
elder care are shown in Table I, along with sample quotes from study participants. In
this section, we describe the themes in more detail.
Difficult events with patients
Theme 1 concerns unfavorable events with patients that elicit a strong emotional
response and/or feelings of uncontrollability. It is comprised of 45 statements, and it is
the 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


Example quotes

Difficult events
with patients

Events with recipients of care that Ongoing deaths are particularly tough
elicit a negative emotional
Its stressful that all you see is patients
response and/or are uncontrollable getting worse over time
Seeing residents with dementia gets me
thinking about my fate that I never
want to get the disease
Even the most patient person at times
will have to walk away. Not everyone
can do this job
On some days, I dont have time to
emotionally support the patients, or get
support myself


Strain from work affects non-work Have emotional demands at home too
time. Workers feel they complete Many employees have elderly parents
the same tasks at home as at work they care for after work


Concerns and demands of patients Family members will write pages of

families; hurtful or neglectful
notes for staff on how to take care of
behavior of family toward patient their family member
In assisted living families often dump
the family member and dont visit

Money and job


Monetary concerns and other job


Personal care attendants do not make a

living wage
Physically challenging, always lifting
and turning people
Stress of people calling off

Table I.
Major themes from the
group interviews
regarding emotional
demands (Study 1)



Table II.
Key sub-themes for
Theme 1: difficult events
with patients (Study 1)

reported being called nasty [racially offensive] names, and she said it made her
wonder if this behavior was part of the condition of dementia, or if that person was
like that before. Other participants said the anxiety present in residents about end of
life issues and seeing patients get worse over time is stressful.
Because Theme 1 comprised nearly half (48 per cent) of the 94 original participant
statements, sub-themes were created. Four of the original 45 statements for Theme 1
were found to include multiple emotionally demanding events and were separated,
creating 49 total statements. Three co-authors and two graduate assistants examined
the 49 statements and agreed on four sub-themes that adequately represented most of
the statements. A fifth theme was added to capture statements that were not included
in the previous four themes. Then, a co-author and two graduate assistants coded the
49 statements for Theme 1, resulting in a kappa of 0.91. The four key sub-themes
related to difficult events are listed in Table II along with sample quotes.
The first sub-theme contains sixteen statements and reflects patient deterioration in
that, patients physical and mental states decline over time. The second sub-theme was
applied to eleven statements and involves patient aggression against caregivers. This
includes physical assault, verbal insults and sexual harassment. Participants reported
a wide range of aggressive behavior ranging from rudeness to sexual groping to
violent outbursts. The third sub-theme was applied to eight statements describing a
lack of control in care work. Participants described the lack of control over and
inability to anticipate patient behavior. The fourth sub-theme described organizational
factors contributing to difficulties with patients and stress. This was assigned to six
No. Theme


Example quotes


Patients physical and mental

states continually declining over

Its hard to see people do things they

wouldnt normally do
Its heartbreaking to watch the
residents decline to the point where they
cant walk or talk.


Physical assault, verbal insults

and sexual harassment

This job is a lot like working with kids.

They dont understand much and can be
mean, sometimes call you names
Residents can be combative and
sometimes catch you off guard

Lack of control

Inability to control or anticipate

patient behavior

You might be a friend to a resident one

day and an enemy the next. You just
have to realize that theyre people
You can be zippidy-do-dah in the
morning and all of a sudden something
will happen and youre sucked dry


Organizational constraints and

lack of respect from co-workers
contributing to emotional

Nurses aides get blown-off by other

staff members because, they didnt go to
college to know when the residents need
a shower. This is frustrating because we
are not listened to by upper level staff
Currently we are overwhelmed with

statements describing difficulties with organizational constraints and a lack of respect

and appreciation from nurses and co-workers. Finally, eight statements were coded as
the last sub-theme that included statements that could not be classified as sub-themes
one through four, such as comforting patients when they are fearful of dying, or
grieving the loss of other residents.

Suppression of

Work/home conflict
Theme 2 involves the idea that job stress affects non-work time and that some
caregivers have additional elder care responsibilities at home. It is comprised of 4
statements; it is the theme with the least statements belonging to it. In one group
interview, it was said that many caregivers take care of elderly parents at home. One
participant 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 stress
Theme 3 refers to the idea that caregivers may experience difficult events with the
families of people with dementia. It is comprised of nine statements. It was said that
some family members do not understand what their loved one is going through,
meaning that caregivers not only support the people with dementia, but also their
family members. Another participant said that she feels guilty when her patients
appear to like her better than they do their own family, but she believes it is because
she spends relatively more time with the person with dementia.
Money and job concerns
Theme 4 is comprised of 20 statements about money and job concerns. One participant
explained that, with aging patients and aging staff, there are more work demands and
fewer staff members who are able to physically accomplish the tasks required by elder
care. On this point, some of the job requirements (e.g. lifting and turning people) are
physically challenging.
Desirable aspects of the job
One theme emerged that was less relevant but contained 13 statements; instead of
emotional demands, it focused on favorable features or rewards of the job. As one
example, study participants complimented fellow staff members (e.g. amazing) and
also the facilities for which they worked. One participant expressed pride in the level of
care provided by the facility for which she worked, saying, We take people no one else
wants. 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 person
with dementia who knows my name and who gives me a look that indicates she
trusts me.
In Study 1, we conducted group interviews to better understand the emotional
demands 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 at
hand namely, difficult events with patients, work/home conflict, patient-family
stress, and money and job concerns. The first theme, difficult events with patients, was



the one most frequently mentioned, indicating that it may represent a relatively salient
cue for emotional labor in elder care. Sub-themes were created and the results show
that the difficult events most frequently mentioned include the declining health of
patients and being treated aggressively by patients.
As mentioned, previous research indicates that assisting and caring for others is a
job activity that is relatively high in emotional demands (Glomb et al., 2004). However the
results of Study 1 suggest that it is not just caring for others in general that is
emotionally demanding, but that there are certain types of events, such as difficult
events with patients (e.g. deterioration, aggression), that may be especially demanding.
These affective events or shocks that elicit felt emotion, such as anger (Weiss and
Cropanzano, 1996), are theorized to motivate employees to use emotional labor strategies
as way of complying with relevant display rules (Grandey, 2000). Other studies in more
prototypical customer environments have focused on, for example, verbal aggression
from customers (Grandey et al., 2004), but in the present study aggression from patients
may include physical assaults, verbal insults, and/or sexual harassment.
Although in our study we did not link these emotional demands with emotional
labor strategies, such as negative suppression, there is previous theoretical and
empirical 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/or
personal value systems, direct care providers may exert effort to produce appropriate
emotional displays in the face of emotional demands (e.g. patient aggression).
Study 2
Emotional labor occurs when employees manage their feelings to create a publicly
observable facial and bodily display that is appropriate for a given work situation
(Grandey, 2000). In her seminal ethnographic research, Hochschild proposed two main
forms of emotional labor, called surface acting and deep acting. Surface acting is an
attempt 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 to
produce 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 of
inappropriate 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, with
certain forms or dimensions having potentially negative consequences for employee
well-being (Wharton, 2009). Surface acting, in particular, has been found to relate
negatively 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 artificially
nice, which is akin to surface acting, to be associated with single-item measures of job
satisfaction and job stress (i.e. less satisfaction, more stress). For deep acting, on the
other hand, the literature is less clear. Some studies have found deep acting does not
relate 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 sense
of personal accomplishment (Brotheridge and Grandey, 2002; Brotheridge and Lee,
2002, 2003).

An alternative to measuring the internal processes of surface and deep acting is to

instead focus on behavioral displays (Ashforth and Humphrey, 1993). This approach
bears the advantage of greater clarity about what is being measured, as well as the
ability to distinguish between positive and negative emotions. In the present study, we
use the conceptualization of emotional labor by Glomb and Tews (2004), who define the
concept as the behavioral expression and non-expression of felt or unfelt emotions in
accordance with display rules. More specifically, we focus on non-expression of felt
negative emotions, called negative suppression. This focus is similar to early interests in
the concept of suppressive work the act of inhibiting the display of an emotion that
would 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 mortality
and incidence of coronary heart disease and hypertension (Mauss and Gross, 2004).
In Study 2, we examined the empirical association between negative suppression
and 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, more
events should result in more effort to regulate emotions, and so should have a cumulative
effect on stress and well-being.

There also exists field research on negative suppression and its association with job
attitudes. The perceived work requirement to hide negative feelings has been shown to
relate to burnout and to ill health (Brotheridge and Grandey, 2002; Schaubroeck and
Jones, 2000), and negative suppression itself has been shown to relate to lower levels of
job satisfaction, even after controlling for emotional expressivity (Cote and Morgan,
2002; see also Grandey et al., 2005). However, in the present study, we tested whether
negative suppression relates to job attitudes after controlling for individual differences
in general mood. This control was necessary from a practical perspective in that we
wanted to establish for human resource managers that any relationships found
between 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 individual
differences in positive affectivity (PA) and negative affectivity (NA) may relate to
emotional 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 job
attitudes that exist apart from relevant associations with PA and NA. The specific form of
our hypotheses was that the more frequently that people report suppressing negative
emotions at work (e.g. anger), the more likely they will be to report feeling higher in job
stress and lower in job satisfaction, which we define as the feelings people have about a
given 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.
Participants and procedure. Direct care providers working in the Midwestern United
States were recruited to participate in the study through flyers posted at their

Suppression of



employing organizations (e.g. in break rooms). Of the 75 direct care providers who
responded 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 fewer
than ten years (79 per cent). The three organizations were different in care type; hence
participants 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 of
three training sessions related to dementia care, for which they had the opportunity to
receive continuing education credits[1].
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 work
during 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 the
frequency with which they kept the emotion to themselves. The response format
was 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) and
Never (1). The subscale demonstrated good reliability (a 0.91).
Job satisfaction: job in general ( JIG). The JIG was used (Balzer et al., 1997; Ironson
et al., 1989) to measure satisfaction with the job in general. This scale has
previously been shown to relate to a number of variables, including intentions to
leave (Ironson et al., 1989). The instructions ask the participants to indicate
whether or not various adjectives or short phrases (e.g. pleasant) describe the
job 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 ? was
scored 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 to
measure job stress. This scale has previously been shown to relate to a number of
variables, including intentions to leave (Stanton et al., 2001). It contains two
subscales, SIG-I (seven items) and SIG-II (eight items), which respectively
measure less and more serious levels of stress. Items on SIG-II include hassled
and overwhelming; items on SIG-I include hectic and demanding. The
instructions ask the participants to indicate whether or not these adjectives and
short phrases describe their job by choosing Yes No or ? (if they cannot
decide). Per Stanton et al., a response of Yes was scored with a 3, No was
scored with a 0, and ? was scored with a 1.5. The SIG subscales demonstrated
good 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 positive
affectivity (PA) and negative affectivity (NA). This scale has previously been
shown to relate to number of variables, including psychological distress and
dysfunction (Watson et al., 1988). Participants were asked to rate the extent to
which they generally feel certain emotions, including ten emotions that are
positive (e.g. excited, active) and ten that are negative (e.g. irritable, guilty). Items

were rated on a five-point scale ranging from Not at all to Extremely. Both
scales 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 at
the end of the survey. In addition we maintained a record of the facility for which
each respondent worked.

Preliminary analyses. Preliminary analyses revealed mean differences in negative
suppression by type of workplace; therefore we created a binary control variable (home
health versus not) for use with all hypothesis tests. The analyses we conducted
included a one-way ANOVA to examine whether respondents reported any differences
in the frequency with which they engaged in negative suppression depending on the
type of facility for which they worked (i.e. nursing home, assisted living, home health
care). The results revealed differences by facility (F2; 63 3:80, p , 0:05), such that
respondents were less likely to report engaging in negative suppression if they worked
in 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 negative
affectivity (NA) and positive affectivity (PA) as control variables. When testing the
relationship between negative suppression and job stress (i.e. SIG-I, SIG-II), we
controlled for the associations between all variables and NA; when testing the
relationship between negative suppression and job satisfaction, we controlled for the
association between negative suppression and NA and between job satisfaction and
PA. Based on the preliminary analyses, we also controlled for whether or not
respondents worked for home health care (i.e. yes, no) on negative suppression. To
appropriately model these control variables, each hypothesis was tested separately
with path analysis following the procedures of Kline (2005) with the correlation matrix
shown in Table III. All path models showed acceptable or good fit, as indicated by the
comparative fit index (CFI), root mean square of approximation (RMSEA), and
standardized root mean square residual (SRMR) reported in the next section; however,
it is the standardized beta weight (b) or association between relevant variables that is
used for hypothesis testing.

Negative suppression
Job satisfaction ( JIG)
Job stress (SIG-I)
Job stress (SIG-II)
Positive affect (PA)
Negative affect (NA)
Home health



Suppression of

0.96 (0.91)
0.48 20.37 * * (0.80)
0.36 * * 20.16
0.67 * * (0.78)
0.83 20.03
0.30 * 2 0.09
0.35 * * 20.30 *
0.47 * *
0.57 * * 0.11
0.47 20.38 * *
0.15 2 0.09
0.13 20.12 n/a

Notes: * p , 0.05, * * p , 0.001; Listwise n 62; Coefficient alphas indicated on diagonal. Home
health 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 for
study variables (Study 2)



Hypothesis tests. Partial support was found for Hypotheses 1, which posited that
negative suppression would relate to job stress. The direct path from negative
suppression 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, the
direct path to SIG-I (i.e. less serious job stress) was significant and in the hypothesized
direction 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 suppression
to 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).
In Study 2, two hypotheses were tested about the relationship between negative
suppression and job attitudes. Support was found for the second hypothesis in that
negative suppression was associated with less job satisfaction. Support for this
relationship has been found previously in a sample of working college students
(albeit with different control variables; Cote and Morgan, 2002), but here we show it
in the context of elder care. Partial support was found for the first hypothesis in
that negative suppression was found to relate to one of the two subscales of job
stress (SIG-I); this is the first study of which we are aware linking negative
suppression 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 job
satisfaction and more job stress, even after accounting for individual differences in
positive affectivity (PA) and negative affectivity (NA). Thus, from the perspective of
human resource management, the results suggest that negative suppression is
associated with undesirable job attitudes, regardless of the general mood of a given
A potential criticism of this study lies in the fact that all of the data were collected
with participant self-reports. Chan (2009) explains the problems associated with
self-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 variables
if there is no evident construct validity (p. 692, emphasis added). Thus, a strength of
our study is that its measures, though self-report, are previously validated. Regarding
the 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 addresses
this to a degree. Podsakoff et al. (2003) explain this strategy for controlling method bias
is somewhat limited in that only controls for that portion of common method variance
that 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 of
self-report data and defines it as the tendency to present ones self in a way that is
favorable with regard to culturally derived standards (Ganster et al., 1983). Thus, in the
survey development stage, we selected measures that avoid value-laden content that

invokes a need to present a favorable impression in the first place. With negative
suppression, for instance, the measure by Glomb and Tews (2004) asks respondents to
indicate the frequency of non-expression of felt negative emotions, as opposed to
measures of similar constructs (like surface acting) that make reference to things like
faking, which some respondents may be motivated to conceal. Also, following
Podsakoff et al., we not only kept our survey items simple, specific, and concise, but we
also used different scale endpoints and formats for the predictor and criterion
measures. In sum, we have no reason to doubt the general pattern of relationships
found between negative suppression and job attitudes.
General discussion
The supply-and-demand problem in elder care is one that will require increasing
attention on the part of society. For human resource management, one question is how
to break the vicious cycle of vacant shifts, job stress, and turnover that characterizes
some elder care organizations (Eaton, 2000, 2001). In the present investigation, we
focus on the suppression of negative emotions as a possible point of organizational
intervention. We conducted group interviews to better understand the emotional job
demands of elder care (Study 1), and we administered a survey to examine the
empirical association between negative suppression and job attitudes (Study 2).
Taken together, the results provide support for the theory that difficult events with
patients interact with display rules to elicit emotional labor, which in turn is associated
with job attitudes (Grandey, 2000). The results of group interviews (Study 1) suggest
that 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 satisfaction
and with greater job stress, regardless of a direct care providers standing in general
affectivity. These two studies are linked to the extent that direct care providers manage
difficult events by working to conceal or suppress felt emotion (e.g. sadness, anger), but
future research needs to examine whether negative suppression acts as a mediator of
the association between difficult events and job attitudes; moreover, these models need
to 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 emotional
disclosure, which is the verbalizing of felt emotions to another person (Smyth and
Pennebaker, 1999; see also McCance et al., in press). In a recent experimental study
conducted in the laboratory (Daniels et al., 2010), post-suppression emotional
disclosure resulted in lower reports of emotional exhaustion as compared to factual
disclosure, but only for individuals relatively low in neuroticism; for those high in
neuroticism, post-suppression emotional disclosure unexpectedly resulted in greater
reports of emotional exhaustion. This pattern of findings suggests that there is the
potential for emotional disclosure to buffer the stressful effects of negative
suppression; however, the results also underscore the need for field research to
measure emotional disclosure as it happens naturally. Also worth considering in future
research are alternatives to negative suppression i.e. healthier ways to manage
emotional 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 is
a component of the emotional labor process over which organizational
decision-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 and
Houlihan, 2005). In this way, call centers may have a backstage where display
rules 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 for
direct care providers to talk about the demands of the job, much less to get away
from those demands. Future research could more systematically examine the
resources available to direct care providers (e.g. break rooms) and whether this
relates to outcome measures of interest.
Up until now our discussion has focused entirely on interactions between direct care
providers and their patients. Importantly, though, a limitation of Study 2 is that our
measure of negative suppression did not ask when or with whom the respondents use
negative suppression at work. The results of Study 1 point to difficult events with
patients 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 through
negative suppression. However, previous research suggests that the events that elicit
emotional labor strategies are distributed across customers, co-workers, and managers
(Basch and Fisher, 2000; Diefendorff et al., 2008). Thus, in Study 2, the target for
negative suppression could be a patient, but it could also be a co-worker, manager, or
even a family member of a patient. In future research on this topic it would be
interesting to include different targets on a given survey. Seery and Corrigall (2010) did
this with nurses aids and childcare workers, with the targets being clients and
family members of clients; the authors found that certain links between emotional
labor and job satisfaction were significant for one target but not the other. Most
relevant to the present investigation is the finding that the relationship between
surface acting (which involves negative suppression) and job satisfaction was only
significant when the surface acting was performed for clients (i.e. not for clients family
Although our focus here has been on the USA, we conclude by highlighting that the
societal 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 under
age 5 for the first time in history. Second, although the majority of older people
currently reside with their family, intergenerational co-residence is on the decline.
Third, the use of professional long-term care for the elderly is becoming increasingly
common (especially in Southeast Asia), as the worlds population is aging rapidly while
the number of potential family caregivers is declining. Related, the increasing
prevalence of dementia is leading a number of researchers and medical practitioners to
raise warnings about the growing need for professional long-term care facilities and
providers. Here we suggest that studying negative suppression and its implications for
human resource management is one way to improve working conditions for direct care
providers, thereby helping to enhance recruitment and retention in this valuable
1. For a detailed description of study procedures, please see Gillespie et al. (2006).

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About the authors

Jennifer Z. Gillespie, PhD, is an Adjunct Professor in the Department of Psychology at University
of South Florida Sarasota-Manatee. Her specialty is Industrial-Organizational Psychology, and
her research interests include work motivation, emotional labor, and job satisfaction. She has
published 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 the
corresponding author and can be contacted at: jzgillespie@sar.usf.edu
Patricia B. Barger earned her PhD in Industrial-Organizational Psychology from Bowling
Green State University in 2009. Her research interests include emotional labor, work stress and
customer service. Her work has been published in such journals as Academy of Management
Journal and Consulting Psychology Journal. She currently works as an Assessment Scientist for
Kronos, Inc.
Jennifer E. Yugo is an Assistant Professor of Management at Oakland University. She
received her PhD in Industrial and Organizational Psychology in 2009 at Bowling Green State
University. Her research interests include the meaning of work, emotional labor, employee
wellbeing and positive organizational scholarship. She has published her research in several
outlets including the Journal of Applied Psychology.
Cheryl J. Conley, MA, LSW, is Program Director at the Alzheimers Association, Northwest
Ohio Chapter. She has worked in the field of aging for more than 20 years, including regional
coordinator of a geriatric education center, director of social services for a county committee on
aging, and adjunct gerontology faculty. Her research interest is in providing practical
interventions for assisting families of persons who have dementia (Dementia: The International
Journal of Social Research and Practice). She is also interested in studying older adults who
return to college and on-campus residences for older adults.
Lynn Ritter, PhD, is the Education Coordinator at the Alzheimers Association, Northwest
Ohio Chapter, a position she has held for over ten years. She is responsible for planning and
implementing professional training. Her dissertation compared staff training programs at
selected dementia-specific LTC facilities. She wrote a chapter in Dementia Units in Long-Term
Care, Developing a therapeutic activities program in a dementia unit. She also worked for
almost 12 years in an LTC facility as activities coordinator, then director of the facilitys
Alzheimers Special Care Unit, the first such unit in northwest Ohio.

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