Differential effects of rude coworkers and patients on nurses' safety performance: an emotional labor perspective

PurposeThis paper examines how nurses differentially respond, both emotionally and behaviorally, to incivility from coworkers (i.e. other healthcare staff) and from their patients. Specifically, the authors explore how coworker and patient incivility distinctly influence the extent to which nurses engage in emotional labor, which in turn, may impact nurses' safety performance. The authors further examine how nurses' hostile attribution biases exacerbate and mitigate these effects.Design/methodology/approachA three-week longitudinal study was conducted with 187 nurses in which they reported their experiences with incivility, surface and deep acting, hostile attribution biases and safety performance (i.e. safety compliance and participation).FindingsPatient incivility led to more surface acting across all nurses. Further, the effects of coworker incivility on emotional labor strategies were conditional on nurses' hostile attribution biases (HAB). Specifically, coworker incivility led to more surface acting among nurses higher on HAB, and coworker incivility led to less deep acting among those lower on HAB. Finally, surface acting was associated with reduced safety participation, and deep acting was associated with greater safety compliance and safety participation.Originality/valueThe nursing context allowed the current research to extend understanding about how incivility affects an unexplored outcome—safety performance. The current research also offers a rare examination of the effects of incivility from multiple sources (i.e. coworkers and patients) and demonstrates the different processes through which incivility from these different sources impacts nurses' ability to perform safely.