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Free To Be You and Me: A Climate of Authenticity Alleviates Burnout From Emotional Labor

Alicia Grandey and Su Chuen Foo Pennsylvania State University

Markus Groth and Robyn E. Goodwin University of New South Wales

Given the emotional nature of health care, patients and their families may express anger and mistreat their health care providers; in addition, those providers are expected to manage their own emotions when providing care—two interpersonal stressors that are linked to job burnout. Integrating conservation of resources (Hobfoll, 2002) and ego depletion (Muraven & Baumeister, 2000) theories, we propose that this creates a resource loss spiral that can be slowed by the presence of a “climate of authenticity” among one’s coworkers. We describe this climate and how it differs from other work climates. We then propose that a work unit with a climate of authenticity should provide a self-regulatory break from emotional labor with patients, thus replenishing resources and buffering against strain from emotional labor. We tested this multilevel prediction by surveying 359 health care providers nested within 48 work units at a large, metropolitan hospital. We find that medical workers experiencing more mistreatment by patients are more likely to be managing emotions with patients, and this response further contributes to the employees’ job-related burnout. As predicted, managing emotions with patients was unrelated to burnout for workers in a unit with a climate of authenticity.

Keywords: authenticity, emotion regulation, emotional labor, health care, burnout, mistreatment, work climate

Job burnout is a state of exhaustion and emotional depletion that is unhealthy for the employee and is linked to absenteeism, turnover, and lower job performance (Grandey, Dickter, & Sin, 2004; Halbes- leben & Bowler, 2007; Wright & Cropanzano, 1998). Moreover, these outcomes are particularly problematic for health care profes- sionals, where absence and decreased job performance can harm patient health as well (Le Blanc, Hox, Schaufeli, & Taris, 2007). Two socioemotional factors have been identified as sources of burnout for health care professionals. First, patients and their family members are often dealing with disease, discomfort, or even death, and they may be unable to regulate their expressions of fear or anger when interacting with health care providers due to fatigue or stress (Demerouti, Bakker, Nachreiner, & Schaufeli, 2001; Leiter & Maslach, 1988; Maslach, 1978). Such negative emotional behavior by patients and their fami- lies is a predictor of care provider burnout (Bakker & Heuven, 2006; Bakker, Schaufeli, Sixma, Bosveld, & Van Dierendonck, 2000). Sec- ond, in addition to accurate diagnoses and safe, efficient treatment, health care professionals are expected to provide good customer service to patients (Drach-Zahavy, 2010), often requiring emotional labor (Hochschild, 1983). Such emotional labor in health care entails

showing interest, concern, and sympathy, while suppressing disgust, frustration, or anxiety, when interacting with the public (Mann, 2005). This underappreciated form of labor has been linked to job stress and burnout (Bono & Vey, 2005; Henderson, 2001). Thus, for health care providers, burnout may be a function of: 1) being the target of customers’ negative emotions, and 2) regulating one’s own emotional expression. Though these predictors are clearly linked, they are nev- ertheless rarely considered together when examining job burnout (see Sliter, Jex, Wolford, & McInnerney, 2010 for a recent exception).

A stream of research has begun to identify personal and situa- tional factors that moderate the burnout from these socioemotional demands. Most work has focused on individual perceptions of one’s resources (i.e., self-efficacy, job autonomy), which can buf- fer against the strain of emotional labor (e.g., Demerouti et al., 2001; Grandey, Fisk, & Steiner, 2005; Heuven, Bakker, Schaufeli, & Huisman, 2006). We respond to the call for greater attention to the broader social context to better understand occupational stress and identify unit-level interventions (Bacharach & Bamberger, 2007). Recent studies have shown that a company’s health poli- cies, rewards for service, and formal support groups create unit- level workplace climates that buffer employees from socioemo- tional work stressors (Drach-Zahavy, 2008, 2010; Le Blanc, et al., 2007). We propose that informal social norms in a work unit— specifically the extent that coworkers value authentic expression of emotions with each other (i.e., a climate of authenticity)—can alleviate burnout experienced from engaging in emotional labor with patients and their families.

Thus, the purpose of this research is to make theoretical, empirical, and practical contributions to the occupational health literature. First, we propose that two socioemotional predictors of burnout— interpersonal mistreatment and emotion regulation—are connected based on the concepts of self-regulatory depletion and resource loss spirals (Hobfoll & Freedy, 1993). Second, self-regulatory resources can be replenished if one has a break from self-regulation (Baumeis-

This article was published Online First August 29, 2011. Alicia Grandey and Su Chuen Foo, Department of Psychology, Penn-

sylvania State University; Markus Groth and Robyn E. Goodwin, Austra- lian School of Business, University of New South Wales, Sydney, New South Wales, Australia.

We thank editor Joseph Hurrell for constructive reviews. This research was funded by a grant of the Australian Research Council (LP0990427). An earlier version of the paper was presented at the 26th annual meeting of the Society for Industrial and Organizational Psychology in Chicago, Illinois, April 2011.

Correspondence concerning this article should be addressed to Alicia Grandey, Pennsylvania State University, 111 Moore Building, University Park, PA 16803. E-mail: [email protected]

Journal of Occupational Health Psychology © 2011 American Psychological Association 2012, Vol. 17, No. 1, 1–14 1076-8998/11/$12.00 DOI: 10.1037/a0025102

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ter, Bratslavsky, Muraven, & Tice, 1998), and that such breaks are more characteristic of a work unit that embraces a climate of authen- ticity than one that does not. Empirically, we provide evidence for these outcomes using survey data collected from hospital employees with direct patient contact (i.e., doctors, nurses, and allied health professionals) from 48 distinct work units. We test whether climate of authenticity is a shared, unit-level construct among coworkers, and whether it reduces (or exacerbates) patient care professionals’ job burnout from emotional labor. The results have implications for why and when job burnout occurs, and yield practical implications for reducing detrimental effects of emotionally demanding work on health care providers.

Interpersonal Mistreatment and Emotion Regulation as Causes of Resource Loss

As a resource-based theory of stress, conservation of resources theory (COR, Hobfoll & Freedy, 1993) provides a theoretical explanation for whether, and most importantly when, emotion regulation with patients contributes to burnout (Brotheridge & Lee, 2002). COR recognizes that many factors, both objective (e.g., money, a home) and psychological (e.g., self-esteem, social sup- port), can be viewed as personal resources. When these factors are threatened or actually lost, these primary resource losses evoke anxiety and distress in the individual, heightening physiological arousal and eventually resulting in exhaustion and health issues (Hobfoll, 2002; Hobfoll & Freedy, 1993). Interpersonal stressors (e.g., conflict, mistreatment, verbal aggression) are recognized among the most threatening causes of stress, posing a threat to self-esteem and self-efficacy, and resulting in greater cortisol response and perceived distress than other stressors (Almeida, 2005). Similarly, the frequency with which customers, clients, and patients mistreat their service providers predicts job burnout, even after controlling for other work and role stressors (Dormann & Zapf, 2004; Grandey, Kern, & Frone, 2007; Maslach, Schaufeli, & Leiter, 2001; van Jaarsveld, Walker, & Skarlicki, 2010).

Further, a prediction unique to COR is that by coping with stressors such as mistreatment can, ironically, induce secondary resource losses. This occurs when the primary stressor evokes coping responses that are ineffective, such that gains from engag- ing in the coping response do not outweigh the losses of the effort expended (Hobfoll, 2002). Mistreatment from patients is likely to yield ineffective emotion regulation strategies that simply satisfy job requirements on the surface (Bolton & Boyd, 2003; Diefen- dorff, Richard, & Croyle, 2006; Lewis, 2005). A medical profes- sional cannot respond to patient anger or frustration with similar emotions; he or she must suppress this emotional response and possibly bring forth a look of concern. Such emotion management as part of work expectations is known as “surface acting” (Hoch- schild, 1983) and is used by employees during interactions with the public.1 In fact, research has demonstrated that, despite feeling anger, employees are likely to respond to angry or rude customers by suppressing or faking emotional expressions (Diefendorff, Richard, & Yang, 2008; Rupp & Spencer, 2006).

Such self-regulatory efforts may suffice for a single episode, but frequent emotion management with patients may result in a net loss of resources, for several reasons. First, the inauthenticity of faking expressions, or surface acting (Brotheridge & Lee, 2002), threatens one’s self-worth and self-efficacy as a caring profes-

sional (Erickson & Wharton, 1997). Second, the act of suppressing emotions requires attentional and energy resources, as exhibited by heightened physiological arousal, lowered glucose levels, and re- duced motivation (Baumeister, Vohs, & Tice, 2007; Richards & Gross, 1999). Third, suppressing felt emotions results in less social connection with others compared to actually showing, or more directly changing, those feelings (Butler et al., 2003; Côté, 2005), and thus reduces social resources. Overall, research has established that modifying expressions through faking or suppressing felt emotions is linked to stress, resource depletion (Baumeister et al., 2007; Gross, 1998), and job burnout (Bono & Vey, 2005), even when taking other stressors into account (Lee, Lovell, & Brother- idge, 2010; Zapf, Seifert, Schmutte, Mertini, & Holz, 2001).

Thus, both mistreatment and emotion regulation have been shown to have unique effects on burnout beyond other stressors. What is less clear is how these two socioemotional demands work together to contribute to burnout. One recent study supported that emotional labor mediates the effects on stress from customer- instigated incivility (Sliter et al., 2010), though their study was different from ours in several key ways (i.e., incivility is a low- intensity and more ambiguous form of mistreatment, this study was conducted in the less emotionally intense context of financial transactions). We expected to find that surface acting partially mediates the relationship of patient-instigated mistreatment and burnout. We propose partial rather than full mediation because mistreatment from patients might influence burnout through cog- nitions, such as perceived unfairness (Bakker et al., 2000; Heuven et al., 2006), or stress appraisal (Brotheridge & Lee, 2002; Die- fendorff et al., 2008; Kern & Grandey, 2007).

In summary, based on COR theory and prior evidence, we predict that mistreatment by patients results in primary resource losses that evoke the coping response of surface acting. Further- more, we predict that job burnout is a function of the extent of mistreatment from patients and their families, and this is partially due to the secondary resource losses from surface acting during those interactions (see Figure 1). Thus:

Hypothesis 1. Health care providers who experience more mistreatment from patients and their families are also more likely to engage in surface acting when interacting with patients and their families.

Hypothesis 2. Surface acting partially mediates the relation- ship between mistreatment by patients and health care providers’ job burnout.

Climate of Authenticity as an Opportunity for Resource Recovery

We now turn to understanding the conditions that protect em- ployees from these resource losses. When resource losses have occurred, the individual is motivated to replenish resources through “emotional respite” (Hobfoll, 2002). We propose that understanding the expressive norms among coworkers explains when self-regulatory efforts with patients result in burnout. Below we present the concept of climate of authenticity, and then explain how it may buffer of the strain from emotional labor.

1 Other responses are also possible, such as deep acting (i.e., modifying feelings), situation avoidance, or venting emotions, but these are less clearly linked to stress and depletion and are not the focus of this study.

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Climate of Authenticity as a Unit-Level Construct

Work groups are likely to vary in the extent to which they encourage and support authentic emotional expressions with group members. For example, qualitative work has revealed that flight attendants and nurses report coping with emotional demands by showing their frustration and concerns with coworkers “back- stage,” out of the public’s view (Hochschild, 1983; Lewis, 2005). A retail organization encouraged “bounded emotionality,” permit- ting appropriate expression of felt emotions among coworkers (Martin, Knopoff, & Beckman, 1998). At the same time, there is also the perspective that only positive emotional expressions are healthy for group dynamics (see Fineman, 2006); in fact, expres- sions of hopelessness, anxiety or frustration may be discouraged because they are unpleasant and bring down the group’s mood (Kelly & Barsade, 2001). Moreover, in health care there can be an expectation for compassionate detachment, such that “getting emo- tional” is viewed as unprofessional (Henderson, 2001; Lewis, 2005).

We expect that there are unit-level variations that we label the climate of authenticity: the perceived acceptance of, and respect for, unit members’ expressing felt emotions when interacting with coworkers. Members in a unit high in climate of authenticity value and encourage expressing felt emotions, especially when they are negative, while those in a unit low in climate of authenticity are uncomfortable with and discourage such emotional expressions. These variations may emerge from bottom-up processes (e.g., member personality, vicarious learning), or top-down processes (e.g., professional training, supervisor feedback), creating shared unit-level norms that meaningfully vary even within the same organization (Ashforth & Humphrey, 1993; Kelly & Barsade, 2001; Kozlowski & Klein, 2000). We propose that variations in this unit climate help to explain the extent of emotional regulation needed while interacting with one’s coworkers, thus potentially buffering—or perhaps exacerbating—the burnout experienced

from regulating emotions with patients. Before explaining the interactive effect we differentiate climate of authenticity from other related constructs; namely, psychological safety, display rules, and social support.

Climate of authenticity and psychological safety. To de- velop the idea of a climate of authenticity as a unit-level phenom- enon, we turned to the climate literature and, specifically, to an established unit-level norm in hospital settings: Psychological safety. Psychological safety is defined as a “sense of confidence that the team will not embarrass, reject, or punish someone for speaking up . . . it describes a team climate characterized by interpersonal trust and mutual respect in which people are com- fortable being themselves” (Edmondson, 1999, p. 354, italics added by authors). Psychological safety originally acknowledged four types of interpersonal risks to image (i.e., being seen as ignorant, incompetent, disruptive, or negative), but the psycholog- ical safety measurement items and resulting literature has primar- ily focused on taking risks by asking questions or identifying mistakes (Edmondson, 1999; Edmondson, 2002). Similarly, theo- ries of and evidence for psychological safety focus entirely on unit-level mistakes and learning, not member stress. Our climate of authenticity construct uses the measurement of psychological safety as a starting point to assess whether team members feel that they can express felt negative emotions without interpersonal risk, and we expand beyond the psychological safety literature by focusing on the outcome of employee burnout.

Climate of authenticity and organizational display rules. Our concept of climate of authenticity is related to the idea of shared norms about expressing emotions, verbally and nonver- bally, or display rules (Ekman, 1993). Work groups develop con- ventions for how members should express their feelings, creating local norms that vary from the broader (e.g., gender, occupational) norms that guide social interactions (Ashforth & Humphrey, 1993; Bartel & Saavedra, 2000; Kelly & Barsade, 2001). Such emotional

Figure 1. Multi-level model based on conservation of resources theory.

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norms among coworkers are less constrained than the emotional norms with customers (Diefendorff & Gregarus, 2009; Tschan, Rochat, & Zapf, 2005) and thus are potentially more likely to vary at the unit level. However, we do not use the label “display rules” because in prior organizational research these are typically mea- sured as individual-level perceptions (see Diefendorff et al., 2011 for an exception) of organizational requirements for positive dis- plays during interactions with customers (Brotheridge & Grandey, 2002). In contrast, climate of authenticity is about a shared, unit- level perception about expressing felt negative emotions during interactions with coworkers. As such, our construct represents a unique, unit-level display rule that is not necessarily organization- ally prescribed, warranting a different label.

Climate of authenticity and social support. Furthermore, climate of authenticity is expected to be a unique form of social support. Within COR, social support is viewed as a resource to the individual (Hobfoll, Freedy, Lane, & Geller, 1990; Hobfoll, 2002), with behaviors that show that persons “are valued for their own worth and experiences and are accepted despite any difficulties or personal faults” (Cohen & Willis, 1985, p. 313). Acceptance of coworkers’ expressions of felt emotions could certainly fall into this definition. However, social support is a “metaconstruct,” a broad label that can include quantity or quality of support, and perceived opportunity or actual supportive behaviors, including listening, empathy, instrumental assistance, and advice-giving (Hobfoll, 2002), which is typically assessed as an individual per- ception of the work context (Halbesleben, 2006; see Bacharach & Bamberger, 2007). In contrast, climate of authenticity is a unit- level perception about a more specific form of supporting the individual: acceptance of self-expressive behavior, which does not necessarily result in actions (e.g., advice, listening) by the mem- bers in response to such expressions. In fact, we propose below that climate of authenticity has unique effects from social support and thus warrants separate consideration.

Climate of Authenticity Moderating the Burnout From Emotional Labor

As proposed above, climate of authenticity is a shared percep- tion about the extent that the unit values and accepts self- expression of emotions among members of the unit, specifically negative emotions. We propose that this is important to under- standing the strain of emotional labor, in that a climate of authen- ticity provides an opportunity to recover depleted resources from the self-regulation of emotional labor.

In an interpersonally challenging interaction, people who are told to suppress their felt expressions experience more depletion and perform worse on self-regulatory tasks compared to people who are told to “just be yourself” (Goldberg & Grandey, 2007; Richards & Gross, 1999; Baumeister et al., 2007). Linking ideas of self-regulatory depletion (Baumeister et al., 1998) and conserva- tion of resources theory (Hobfoll, 1989), this can be explained as a self-protection impulse to conserve resources by reducing self- regulation efforts (Muraven, Shmueli, & Burkley, 2006). Simi- larly, people who frequently regulate their emotions during inter- actions with some people (i.e., customers) will be able to conserve resources if they feel able to reduce self-regulation with other people (i.e., coworkers, supervisors). Situational factors such as social expectations or consequences may motivate them to con-

tinue to self-regulate (Muraven & Slessareva, 2007), at a cost to themselves.

Specifically, when the work unit does not have a climate of authenticity—if it does not value and encourage self-expression— employees must stifle their impulse to conserve resources and must continue to regulate their emotions around coworkers, or else experience additional resource losses due to the social conse- quences of violating unit norms. In these units, the depletion from surface acting around patients may be exacerbated by the contin- ued effort of monitoring and self-regulating among coworkers (Baumeister et al., 1998). In contrast, within units that have a climate of authenticity, employees feel safe being authentic— perhaps expressing previously suppressed frustration or sadness about work events around coworkers. In other words, they can take a break from effortfully monitoring and regulating their self- presentation (Vohs, Baumeister, & Ciarocco, 2005). Although regulating emotional expressions in one’s job can be draining, taking a break from self-regulatory activities can improve subse- quent performance (Trougakos, Beal, Green, & Weiss, 2008). Similarly, a climate of authenticity provides an opportunity to take a self-regulatory break and replenish resources lost (Muraven & Baumeister, 2000; Muraven et al., 2006). Given this reasoning and evidence that such recovery opportunities reduce self-regulatory depletion, climate of authenticity in a work unit is expected to replenish resources from surface acting during patient interactions, thus reducing burnout from such self-regulation while having little benefit to those who infrequently surface act with patients.

Moreover, if climate of authenticity works by providing self- regulatory resource recovery, this effect would be specific to the relationship of surface acting and burnout, and it would not be expected to buffer the strain from primary resource losses of patient-instigated mistreatment. In contrast, if climate of authen- ticity functions as unit-level organizational display rules, simply communicating the need to regulate emotions, or as social sharing and support from others, it would moderate the relationship of emotional demands (i.e., mistreatment by patients) on both surface acting and burnout, as found previously (Diefendorff et al., 2011; Goldberg & Grandey, 2007; McCance, Nye, Wang, Jones, & Chiu, in press; Le Blanc, et al., 2007). Since we expect that climate of authenticity works as a self-regulatory break, we predict only that:

Hypothesis 3. Unit-level climate of authenticity moderates the relationship between surface acting and job burnout; the pos- itive relationship is strengthened when climate of authenticity is lower, and is weakened when climate of authenticity is higher.

Method

Participants and Procedure

All health care providers with patient contact at a large metro- politan hospital in Australia were invited to participate in the study as part of a wider organizational development project. Out of approximately 812 patient-contact employees, 492 returned com- pleted surveys (overall response rate of 60.6%). Given our interest in unit-level contexts, we limited our analyses to respondents who: 1) spent at least 50% of their time working within a primary work unit, and 2) worked in units from which we received at least two survey responses. This reduced our total sample to 359. This final sample was 86.9% female, with a mean age of 37.17 years (stan-

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dard deviation [SD] � 10.80) and average job tenure of 7.04 years (SD � 7.64). Out of the 359 participants, 55.3% were nurses, 30.6% were allied health professionals (e.g., speech therapists, clinical psychologists, physiotherapists, occupational therapists), and 14.2% were medical professionals (e.g., surgeons, physicians). Respondents were not financially compensated for their participa- tion, but did receive edible treats during recruitment. We distrib- uted the survey in paper-and-pencil format during unit meetings and also made it available online using password-protected access. Completed paper-and-pencil surveys were returned to the re- searchers in person or by using reply paid envelopes. Time was allocated for staff to complete the surveys during work hours.

The hospital employs a cross-functional team-based structure in which members provide holistic care to patients, working as teams within clinical groups (i.e., emergency department, neurology, orthopedics), professional groups (i.e., psychology, speech pathol- ogy), or wards (i.e., geographical areas of patient care within the hospital). Although some hospital employees were part of multiple teams within the hospital, respondents in our survey were in- structed to respond to the team-based questions considering only their primary teams (i.e., the team a respondent spends the most time with). There were 48 different teams represented by 359 participants and an average of 7.3 respondents per unit, ranging from 2 to 28 respondents, who averaged 5.06 years (SD � 6.03) with their team. The exact response rate per team was impossible to determine because the hospital did not keep team membership records and members could be on more than one team (though we limited our sample to those who spent at least 50% of their time with a primary team). The overall 61% individual response rate and discussions with hospital unit leaders suggests our response rate per teams was a representative sampling of team members. If some units did have very low response rates, this would likely create unstable or low agreement within the climate of authenticity measure in those units; however, all but three of the units demon- strated internal rwg values (an index that conveys mean interrater agreement within the groups) that exceeded desirable levels (.70). Overall, the sample was representative of the hospital’s care pro- viders and work units.

Measures

Means, standard deviations, and correlations can be found in Table 1. Responses were on a scale from (1) � never to (5) � always unless stated otherwise.

Climate of authenticity. Climate of authenticity was as- sessed with a seven-item measure developed for this study. We modified Edmondson’s (1999) measure of psychological safety climate to refer to the perceived acceptance in the unit for showing felt emotions (see Appendix). Respondents were asked the extent to which the items applied to their primary team, ranging from (1) � doesn’t apply at all to (5) � applies entirely. Descriptive statistics at the individual level are shown in Table 1. In the results section below we provide evidence for aggregating these individ- ual perceptions into a unit-level construct (Hofmann, 1997), as well as convergent and discriminant validation evidence.

Mistreatment by patients. We modified the interpersonal conflict at work scale (ICAWS; Spector & Jex, 1998). The mod- ified four items specify mistreatment behaviors performed by the public (i.e., patients and their families), and importantly we ask

about personal experiences as well as observed mistreatment to- ward other team members (see Appendix). Experienced mistreat- ment is a low base rate behavior; including observed mistreatment reduces this statistical issue. This approach also captures mistreat- ment in the broader employee-patient context; vicarious mistreat- ment creates a sense of “moral outrage” that is similar to experi- enced mistreatment (Skarlicki & Rupp, 2010), especially when person mistreated is a friend or coworker (Spencer & Rupp, 2009). Finally, including observed mistreatment allows us to meaning- fully aggregate these items to represent unit-level mistreatment. Though our main predictions about mistreatment by patients uti- lize individual perceptions, we recognize that hospital work units are likely to experience varying levels of mistreatment from pa- tients (Le Blanc, et al., 2007), and these differences may contribute to variations in burnout. A one-way analysis of variance (ANOVA) supported that a significant amount of variation in mistreatment perceptions was due to the unit [F(47, 308) � 2.85, p � .01, ICC(1) � 0.30].2 We control for unit-level differences in mistreatment by patients to isolate the effect of the individual’s perceptions on burnout.

Surface acting. Emotion regulation was measured with the most well-validated measure of surface acting (Brotheridge & Lee, 2002), with three items that ask about the frequency of regulating emotional expressions (i.e., resist expressing, hide true feelings, pretend to have emotions) when interacting with patients or their families.

Emotional exhaustion. Emotional exhaustion is the primary dimension of burnout, measured here with six items by Wharton (1993). This scale directly assesses the focal construct of job- related emotional exhaustion rather than other dimensions of burn- out or other forms or sources of fatigue, and is often used in the emotional labor literature (e.g., Chau, Dahling, Levy, & Diefen- dorff, 2009; van Jaarsveld, Walker, & Skarlicki, 2010).

Control variables. We controlled for several variables in our analyses. First, gender of respondents (1 � male, 2 � female) is associated with reporting of burnout as well as surface acting (Johnson & Spector, 2007). Second, tenure with the hospital (i.e., length in years) was included as a control because it has been shown to be a predictor of burnout due to expended energy over time (Zohar, 1997). Finally, we controlled for respondent occupa- tional status, specifically whether the respondent was a nurse (1 � nurse, 0 � other). Nurses spend more face-to-face time caring for patients than the medical or allied health professionals, and also tend to be viewed as lower in status due to gender, educational and occupational differences (Devine, 1978; Fagin & Garelick, 2004; Fox, 2000). Frequency of contact and status are related to patient- instigated mistreatment, surface acting, and burnout (Diefendorff & Greguras, 2009; Grandey et al., 2007), and thus we control for occupational status to reduce the likelihood that our variables are spuriously associated.

Results

Since climate of authenticity is a new construct using a modified scale, we conducted tests for discriminant validity evidence as well

2 Since patient-instigated mistreatment was an additive construct (Chan, 1998), we did not compute the interrater agreement, rwg(j).

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as evidence for aggregation to the group level. We then turn to the analytic approach and results of the hypothesis testing.

Climate of Authenticity: Psychometric and Discriminant Validity Evidence

As a preliminary step, we wanted to ensure that individual perceptions of climate of authenticity were not redundant with team social support perceptions. A separate sample of hospital workers who did not meet our main study criteria (N � 211) received the climate of authenticity items (alpha � .78) and three team support items (alpha � .81; based on Marks, Mathieu, & Zaccaro, 2001). Confirmatory factor analyses supported that a two-factor model was a better fit than a one-factor model [��2(1) � 133.80, p � .01]. This initial evidence supports the internal consistency of the climate of authenticity items and that perceptions of climate of authenticity were discriminant from team support.

Next, with our main team-based sample we needed to provide both validity and aggregation evidence. First, we needed to show that our individual-level self-reported measures were distinct from each other, and particularly that climate of authenticity perceptions were unique from burnout, mistreatment by patients, and surface acting with patients. To do this we conducted a series of confir- matory factor analyses. First, we compared the fit of our hypoth- esized four-factor model to one with a single factor (i.e., common method factor). The overall fit statistics for our four-factor model indicate a good fit to the data: �2 (164, N � 345) � 327.43, p � .01; comparative fit index (CFI) � .95; incremental fit index (IFI) � .95; Tucker-Lewis index (TLI) � .93; root mean square error of approximation (RMSEA) � .05. The model fit was sig- nificantly better than that for a one-factor or common method model [� �2(6) � 1575.50, p � .01], thus climate of authenticity was discriminant from the other individual perceptions of the work situation.

We also compared a two-factor model to a one-factor model for every pair of factors in the measurement model, as suggested by Bagozzi, Yi, and Phillips (1991). For each combination of mea- sures, the two factor model had a significantly better fit than the one-factor model. Finally, we calculated the average variance extracted for each pair of constructs, which exceeded the square of the correlation between the two constructs in each case, demon- strating further evidence of discriminant validity of our measures (Fornell & Larcker, 1981). These steps confirm that the items

representing individual perceptions of climate of authenticity are best modeled as a unidimensional structure and are distinct from the other three self-reported measures in our model. This finding is also consistent with prior evidence (e.g., Diefendorff & Gregarus, 2007; Tschan et al., 2005); employees differentiate between emo- tional expressions shown to patients (i.e., surface acting items) and to coworkers (i.e., climate of authenticity items).

Next, we needed to justify aggregating climate of authenticity to create a unit-level construct. Doing so requires assessing both agreement within groups and variability between groups (Hofmann, 1997). We computed the intraclass correlation co- efficient, referred to as ICC(1), using one-way random ANOVA to identify between-groups variability (Bliese, 2002; Shrout & Fleiss, 1979). Additionally, we computed the rwg(j) as an index that conveys mean interrater agreement within the groups (James, 1982). The one-way ANOVA indicated significant between-groups variance in climate of authenticity [F(48, 310) � 3.38, p � .01, ICC(1) � 0.34]. The average rwg(j) for climate of authenticity was .87, which exceeded the minimum level of average within-group agreement of 0.70 (James, 1982); more- over, all but three units were above the .70 level, further justifying our aggregation efforts. Together, these statistics show acceptable levels of within-group agreement and between-groups variability in climate of authenticity, and we can examine this construct at the unit level.

To provide evidence of discriminant validity for the aggregated construct, we looked at the unit-level relationships of climate of authenticity and patient mistreatment. If climate of authenticity is simply a function of unit-level variations in the stress of the work environment (e.g., the frequency of negative emotions), rather than unit-level expressive norms, these variables would be positively correlated. We found evidence for discriminant validity, with climate of authenticity unrelated to unit-level mistreatment by patients (r � –.06, p � .10); thus, regardless of frequent negative interactions with patients and their families, some groups have a climate of authenticity and others do not.

In short, the evidence supports that responses to the climate of authenticity items were unidimensional, internally consistent, and discriminant from perceptions of team support, patient mistreat- ment, surface acting, and burnout, and were likely to be shared by unit members and be different across units. Thus we proceeded with hypothesis testing.

Table 1 Means, Standard Deviations, and Individual-Level Correlations and Reliability Estimates

Variable M SD 1 2 3 4 5 6 7

1. Gendera 1.87 0.34 — 2. Organizational tenure 7.00 7.62 0.14�� — 3. Occupational statusb 0.55 0.50 0.30�� –0.03 — 4. Mistreatment by patients 1.85 0.83 0.12� –0.10 0.35�� 0.90 5. Surface acting with patients 3.29 0.77 0.06 –0.03 0.10 0.17�� 0.68 6. Emotional exhaustion 2.74 0.75 0.12 –0.10 0.14�� 0.31�� 0.17�� 0.88 7. Climate of authenticity 3.72 0.42 0.03 0.04 –0.07 –0.09 –0.11� –0.36�� 0.85

Note. N � 359. Cronbach’s alphas are in italics on the diagonal. a 1 � male; 2 � female. b 1 � nurse; 0 � other. � p � .05. �� p � .01.

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Hypothesis Testing: Analytic Approaches and Main Results

Since we have cross-level predictions and our respondents may have nonindependent responses due to working in units with similar physical resources, types of patient care, and coworkers, we use multilevel analyses in SAS 9.2. This approach permits assessment of variance at the group and individual level, and cross-level relationships, without having to aggregate individual responses to the unit level or disaggregate unit-level constructs to the individual level (Bryk & Raudenbush, 1987; Hofmann, 1997).

Mistreatment by patients predicting surface acting. Hy- pothesis 1 predicts that individual-level frequency of mistreatment by patients and their families is positively related to surface acting (e.g., hiding or faking emotions) when interacting with those persons. We tested this prediction at the individual-level, while also controlling for individual level characteristics and unit-level variations in mistreatment by patients. As shown in Table 2, individual perceptions of mistreatment by patients were signifi- cantly and positively associated to the use of surface acting when interacting with patients (�40 � 0.17, p � 0.01, lower CL � 0.05, upper CL � 0.28; Model 1). Thus Hypothesis 1 is supported. Moreover, unit-level climate of authenticity was unrelated to individual-level surface acting with patients (�01 � �0.03, p � .05, lower CL � �0.24, upper CL � 0.18), supporting that group norms for expressing emotions with coworkers does not influence the frequency of emotion regulation performed with patients.

Surface acting as partial mediator of mistreatment on burn- out. We proposed that mistreatment by patients and their fam- ilies results in primary resource losses, and that surface acting when interacting with patients creates secondary resource losses

with unique effects that partially explain the burnout from mis- treatment. We used the conservative four-stage mediation test (Baron & Kenny, 1986; Kenny, Kashy, & Bolger, 1998), and the results of the multilevel regression analysis are shown in Table 2. First, we find that individual perceptions of mistreatment by pa- tients were significantly and positively associated with emotional exhaustion (�40 � 0.23, p � 0.01, lower CL � 0.13, upper CL � 0.34; Model 2). Second, mistreatment by patients was associated with the potential mediator, surface acting, as demonstrated in the test for Hypothesis 1. For the final steps, both the predictor (i.e., mistreatment by patients) and mediator (i.e., surface acting) were included in the prediction of exhaustion. Surface acting was found to be positively and significantly associated with emotional ex- haustion beyond mistreatment (�50 � 0.13, p � .01, lower CL � 0.03, upper CL � 0.23; Model 3), and the effect of mistreatment by patients on exhaustion was reduced slightly (�50 � 0.21, p � .01, lower CL � 0.10, upper CL � 0.32; see Model 3), suggesting support for our prediction of partial mediation (Kenny et al., 1998). A Sobel test further suggested that mistreatment by patients had an indirect effect on exhaustion (z � 1.91, p � .05) due to surface acting (MacKinnon, Lockwood, Hoffman, West, & Sheets, 2002). Overall, both mistreatment by patients and surface acting with patients have unique effects on burnout, and we find some support for indirect effects as proposed in Hypothesis 2.

Interaction of surface acting and climate of authenticity on burnout. Hypothesis 3 proposed that a unit’s climate of authen- ticity buffers individual employees’ resource depletion from sur- face acting. First, we assessed the predicted cross-level moderating effect, to see if the slope of the Level-1 relationship between surface acting and exhaustion varies based on Level-2 climate of

Table 2 Results From Multilevel Analysis Predicting Surface Acting and Employee Burnout

Level and variable

Surface acting Emotional Exhaustion

Model 1 Model 2 Model 3 Model 4

Effects Lower

CL Upper

CL Effects Lower

CL Upper

CL Effects Lower

CL Upper

CL Effects Lower

CL Upper

CL

Level 1: Employee Intercept 2.93�� 2.34 3.52 2.34�� 1.78 2.90 1.96�� 1.34 2.59 0.98 �1.55 3.50 Gendera 0.07 �0.17 0.32 �0.10 �0.33 0.13 �0.11 �0.34 0.12 �0.06 �0.29 0.16 Organizational tenure 0.00 �0.01 0.01 �0.01 �0.02 0.00 �0.01 �0.02 0.00 �0.01 �0.02 0.00 Occupational statusb 0.04 �0.16 0.23 0.06 �0.13 0.25 0.05 �0.14 0.24 0.03 �0.14 0.21 Mistreatment by patients 0.17�� 0.05 0.28 0.23�� 0.13 0.34 0.21�� 0.10 0.32 0.21�� 0.10 0.31 Surface acting with patients 0.13�� 0.03 0.23 0.90� 0.15 1.65

Level 2: Work unit Mistreatment by patients �0.05 �0.29 0.19 0.10 �0.13 0.33 0.10 �0.12 0.33 0.08 �0.13 0.29 Climate of authenticity (CA) 0.26 �0.41 0.93

Cross-level Surface acting � CA �0.21� �0.41 �0.01 SD of Intercept 0.29 0.27 0.31 1.25 SD of Residuals 0.56 0.48 0.48 0.46 �2 Residual Log Likelihood 818.8 770.4 767.8 751.4 � �2 Residual Log Likelihood 48.4 2.6 16.4 n (Level 1) 359 359 359 359 n (Level 2) 48 48 48 48

Note. Lower CL � Lower confidence interval; Upper CL � Upper confidence interval. a 1 � male; 2 � female. b 1 � nurse; 0 � other. � p � .05. �� p � .01.

7CLIMATE OF AUTHENTICITY AND EMOTIONAL LABOR

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authenticity. As shown in Table 2 (Model 4), beyond the control variables and main effects, the interaction term of Level-2 climate of authenticity and Level-1 surface acting had a significant effect on emotional exhaustion (�51 � �0.21, p � .05, lower CL � �0.41, upper CL � �0.01). To facilitate interpretation of the interaction, we plotted the simple slopes at one standard deviation above and below the mean of unit-level climate of authenticity (see Figure 2). For units with low climate of authenticity, the simple slope for the relationship between surface acting and emotional exhaustion was significantly positive (b � 0.94, standard error [SE] � 0.35, � 0.97, t � 2.69, p � .01); for employees working in units with high climate of authenticity, the relationship between surface acting and emotional exhaustion did not differ significantly from zero (b � 1.14, SE � 0.44, � 1.18, t � 2.61, p � .05). This supports that a low climate of authenticity exacerbates the resource depletion from self-regulating with patients, but high climate of authenticity replenishes the self, buffering against depletion. Fur- thermore, climate of authenticity had little benefit for employees who infrequently surface acted (see Figure 2), supporting that this climate specifically provides an opportunity for self-regulatory recovery, as predicted. Overall, these results support Hypothesis 3.

Additional Analyses

Our theoretical reasoning led us to predict that climate of authenticity replenishes self-regulatory resources lost by surface acting (Muraven & Baumeister, 2007). An alternative possibility is that this climate buffers the primary resource losses from interper- sonal stressors (i.e., patient-instigated mistreatment), perhaps by providing social support (McCance, et al., in press). To test for this alternative, we first tested the cross-level interaction of climate of authenticity with patient mistreatment on surface acting, and found it did not have a significant effect (�41 � �0.15, p � 0.10, lower CL � �0.39, upper CL � 0.09). Second, we included the unpre- dicted moderator term (i.e., Mistreatment � climate of authentic- ity) in our equation for burnout to rule out unintended effects (Muller, Judd, & Yzerbyt, 2005). The unpredicted interaction term did not have a significant effect (�41 � �0.10, p � 0.10, lower

CL � �0.32, upper CL � 0.12) while the expected interaction effect with surface acting was still present, although slightly less robust (�51 � �0.18, p � 0.10, lower CL � �0.39, upper CL � 0.03). Thus, the direct effect of the predictor (i.e., mistreatment) on the mediator (i.e., surface acting), and its indirect effect through the mediator on burnout, does not depend on climate of authen- ticity.3 Overall, climate of authenticity works specifically as a self-regulatory recovery opportunity rather than a social support climate.

Discussion

Verbal mistreatment by the public (i.e., patients and their fam- ilies), and the suppression or modification of emotional expres- sions when interacting with the public (i.e., surface acting), are two frequently studied socioemotional demands placed on health care providers (i.e., Bakker et al., 2000; Lewis, 2005). They are nev- ertheless seldom jointly examined as predictors of job burnout, despite earlier arguments for their linkage (Grandey, 2000; Zapf et al., 2001). We developed and empirically tested a model based on the ideas of the conservation of resources model (Hobfoll, 2002; Hobfoll & Freedy, 1993), which conceptualizes patient-instigated mistreatment as a primary source of resource loss, and surface acting when interacting with patients as an ineffective coping response that results in secondary resource losses and thus is proposed to further explain the phenomenon of job burnout among health care providers.

Most of the attention that has been given to possible buffers of such resource losses has been on individual-level factors (Heuven et al., 2006; Johnson & Spector, 2007), but recent authors have called for more attention to the broader work context as a buffer of strain (Bacharach & Bamberger, 2007; Johns, 2006). Consistent with the COR and self-regulatory resource depletion models (Baumeister et al., 1998; Muraven et al., 2006), we propose that working in a context that encourages a break from self-regulation among coworkers—a “climate of authenticity”—buffers the neg- ative impacts of self-regulation during interactions with patients. In doing so, we move the focus from individual-level buffers of emotional labor to the broader, unit-level social context.

Our study makes several important contributions to the occupa- tional health literature. First, COR theory was successfully applied as a theoretical lens to understand how mistreatment by patients and surface acting work together to cause burnout as primary and secondary resource losses, respectively. For patient care providers, frequency of mistreatment by the public (i.e., patients and their families) seems to result in resource losses, since it is positively related to a sense of emotional exhaustion. Moreover, the more frequent the mistreatment from the public, the more likely the care providers engage in surface acting—suppressing and faking their

3 As an additional test of indirect effects, we ran a bootstrapping analysis to generate 1,000 estimates of the coefficients and product of coefficients, and using these generated coefficients, we obtained the 95% bias-corrected confidence intervals of these coefficients at 1 standard deviation (SD) above and below the mean for climate of authenticity (Edwards & Lambert, 2007; Stine, 1989). Based on these confidence intervals, which included 0 [�1 SD 95% CI (0.01, 0.08), 1 SD 95% CI (�0.02, 0.02), 95% CI of the difference (0, 0.08)], climate for authenticity did not moderate the indirect effect of patient-instigated mistreatment on burnout, consistent with the regression analysis.

Figure 2. Graph of the individual-level relationship of surface acting and emotional exhaustion moderated by unit-level climate of authenticity.

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emotional expressions—when caring for those persons (Grandey, 2000; Gross, 1999). Although perhaps effective in the short term, self-regulating emotional expressions by surface acting results in depletion and exhaustion beyond the effects of the interpersonal stressor itself (Richards & Gross, 1999; Vohs et al., 1999). This evidence is consistent with prior workplace research; in call center simulations, simulated mistreatment by customers resulted in an- ger and effortful self-regulation (Rupp & Spencer, 2006), and in diary studies of service workers, workplace anger events elicited more emotion regulation (Diefendorff et al., 2008; Grandey, Tam, & Brauburger, 2002). Unique to our study, we show that this emotional modification helps to explain who experiences burnout, beyond mistreatment, consistent with the idea of secondary re- source losses. Thus, employees who react to mistreatment by patients by suppressing their emotional responses may do their health a disservice in the long run.

Second, we extended the ideas of COR to identify an element of the social context that is likely to moderate the secondary resource losses attributable to surface acting. Much attention has been given to the idea of self-regulation working like a muscle (Baumeister et al., 2007) such that regulation of impulses such as emotional expression results in depletion and fatigue. Thus, factors that provide a respite from self-regulation are thought to reduce depletion (Muraven & Baumeis- ter, 2000). Though many have suggested that health care providers turn to their coworkers to vent their emotions “backstage” (Hoch- schild, 1983; Lewis, 2005), we proposed that work units vary in the extent to which they provide such a break from self-regulation with- out social consequences.

Specifically, we proposed the existence of a climate of authentic- ity—the perceived acceptance and safety for expressing felt emotions with coworkers—that varies by work unit. This construct was mod- eled on the psychological safety climate construct (Edmondson, 1999), as a shared perception that the group encourages interpersonal risks without social consequences, but is distinguished from this earlier construct by our focus on expressive behavior. We argue that this construct is also unique from perceptions of social support, and we find that hospital workers differentiate their perceptions of a climate of authenticity with their unit of coworkers from their per- ceptions of team support with the same coworkers, supporting the unique nature of this type of team perception. Moreover, climate of authenticity was differentiated from organizationally mandated dis- play rules focused on interactions with the public. In support of this we found that work units with emotionally demanding patients were no more or less likely to have a climate of authenticity among coworkers; some units choose to respond to such conditions by being more accepting of venting to coworkers and other units respond by avoiding such emotional expression. Finally, we found that climate of authenticity was a unidimensional construct that is shared by unit members and differentiates units from each other.

Most important, we found that this unit-level climate buffered against the resource depletion of surface acting when interacting with patients. Prior work has shown that a service climate (i.e., manage- ment practices that support health, or reward service) moderates the strain of interpersonal behaviors with patients (Drach-Zahavy, 2008, 2010). To the authors’ knowledge, this is the first study to investi- gate—and find—unit-level emotion norms as a moderator of the well-established relationship between surface acting and burnout. Our results show that a climate of authenticity buffers the strain of surface acting, and not the strain from mistreatment, which is consistent with

the self-regulation and resource depletion models. Specifically, cli- mate of authenticity promotes a break from self-regulation (Muraven et al., 2006), thus it replenishes the resources depleted by self- regulation (i.e., surface acting) while having little benefit for those not self-regulating. The fact that climate of authenticity does not moderate the relationship of mistreatment by patients on surface acting or burnout supports that it is unique from display rules and social support (e.g., venting, advice), which have shown such buffering effects (Diefendorff et al., 2011; McCance, et al., in press). In other words, mistreatment from patients and their families is associated with burn- out regardless of the climate of authenticity among coworkers; but if employees are engaging in surface acting with their patients, the climate of authenticity is helpful in reducing their strain.

Limitations and Future Directions

Several limitations of this study need to be addressed. Our variables of interest are measured by self-perceptions consistent with our theoretical model (i.e., COR; perceived threats, exhaus- tion); however, our approach increases the likelihood of common method variance as an explanation for the identified relationships. We have addressed this limitation in several ways (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). First, we assured respon- dents of confidentiality and had them return their responses di- rectly to the researchers to reduce social desirability response biases. Second, we controlled for individual- and unit-level factors that might spuriously increase relationships among our variables, and conducted confirmatory factor analyses to provide evidence against the argument that the construct associations exist merely due to response biases. Third, while common method variance may increase the direct individual-level associations (i.e., Hypoth- eses 1 and 2), it is less likely to explain the cross-level moderated relationship (i.e., Hypotheses 3).

We cannot rule out the possibility that the variables have a reversed or reciprocal causal pattern; however, the directionality of our proposed model and results are informed by established theory (i.e., COR, ego depletion, emotion regulation). Moreover, recent longitudinal data have supported this causal flow such that surface acting predicts subsequent burnout and not the reverse (Hülsheger, Langa, & Maier, 2010) and lab studies manipulating emotion regulation have shown causal effects on non-self-reported, physi- ological indicators of fatigue (Hopp, Rohrmann, Zapf, & Hodapp, 2010). Thus, while reciprocal effects are possible, our proposed model is consistent with current theories and evidence. A next step is to replicate our proposed model with longitudinal and within- person data. For example, a within-person investigation assessing the emotional demands by time of day would advance our theo- retical ideas: emotional demands (i.e., mistreatment and surface acting) should be greater during visiting and waking hours, and episodic depletion from such shifts is likely to depend on whether one has both the opportunity to interact with one’s coworkers as well as a climate that permits recovery of one’s self-regulatory resources.

Our investigation was restricted to health care professionals at a large hospital. This may be considered a strength in that this truly involves managing strong emotions; many prior studies of emo- tional labor and mistreatment have been conducted in less emo- tionally demanding service contexts, such as simulated call centers (Rupp & Spencer, 2006). Our study also benefits from a broader

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sampling than many other related studies of health care providers, which have focused on certain occupations such as oncology units or pediatric nurses (Le Blanc, et al., 2007; Lewis, 2005); thus, we were able to assess unit-level differences in unique ways. How- ever, because hospitals are distinct contexts in terms of the emo- tional demands they place on their employees, we must be cautious in generalizing the results of this study to other service contexts (e.g., food services). Future research is needed to compare primary and secondary resource depletion effects and the impact of climate of authenticity in different team-based service organizations.

Our concept of climate of authenticity is grounded in theory pertaining to workplace display rules (Diefendorff & Greguras, 2009), psychological safety in teams (Edmondson, 1999), and social support (Hobfoll, 2002); however, further research is needed to assess whether climate of authenticity is empirically distinct from these related concepts and to test the unique contribution beyond these other concepts. Though some overlap of climate of authenticity with display rules, psychological safety, and support- ive climate is likely, the increasing evidence on focal (rather than molar) climates suggests there is value in the more specific climate of authenticity for understanding employee health and perfor- mance. In fact, organizations vary in their level of acceptance of authentic emotions (Fineman, 2006; Martin et al., 1998), thus, future research might extend this study by examining unit-level climate of authenticity within organizational-level variations in such climates (Zohar & Luria, 2005).

Finally, our model, like most models, is underspecified in that we do not exhaust all possible predictors of surface acting, job burnout, or climate of authenticity. Our goal was to provide an initial test of the relative effects of mistreatment and surface acting on burnout, and future research should continue to build on these findings by including additional stressors such as shift work, work overload and interpersonal conflict between supervisors and co- workers (Grandey et al., 2007; Lee et al., 2010) to test the robust- ness of these results. Another possibility is to include emotion regulation strategies where medical staff may work to modify their internal thoughts or feelings, known as deep acting, as well as surface acting (see Bono & Vey, 2005). Expanding the criteria domain, we would expect that by reducing burnout from surface acting, climate of authenticity would also improve task perfor- mance (Baumeister et al., 2007) and reduce absences (Grandey et al., 2004). One concern is that being free to express negative emotions among coworkers could exacerbate negative feelings and result in “breaking character” with patients (Grandey, 2003); how- ever, our results found no relationship between climate of authen- ticity and surface acting with patients suggesting differentiation in expression by target (see also Diefendorff & Greguras, 2009).

Finally, research is needed on the antecedents of this climate of authenticity. As a bottom-up factor, similarity among members is likely to increase a sense of safety and self-disclosure with others (Edmondson, 2002; Phillips, Rothbard, & Dumas, 2009). Thus, gender, racial and cultural diversity is likely to play a role in the climate of authenticity, especially given different norms about emotional displays and regulation (Matsumoto, Yoo, & Fontaine, 2008). As a top-down factor, the behavior of unit leaders and high-status members is likely to contribute to norms concerning expression of emotions (Pescosolido, 2002; Wilk & Moynihan, 2005).

Practical Implications

The present research yields some important implications for managers. First, the results clearly show the cost to employee health when employees serve persons who verbally abuse them and, moreover, when they must maintain professional composure in response to such treatment (Hochschild, 1983; Zapf et al., 2001). In our sample, we find units reporting no mistreatment (M � 1.00) were in education (i.e., Professional & Educational Development, School Therapy, Community Child Health), units with rare but occasional mistreatment (M � 2.00) were dealing with challenging illnesses (e.g., Endocrinology, Allergy, Infec- tious Diseases, Intensive Care Unit), while the units with more frequent mistreatment from patients and their families deal with uncontrollable and unpredictable issues (e.g., Outpatient Services, Child Protection Services, Adolescent Surgical Ward, Inpatient Mental Health). Identifying such conditions and the practices (i.e., long waits, too much paperwork, rude employees) that predict mistreatment is a first step for decreasing work stress.

However, given the emotional challenge of the hospital setting, mistreatment by patients and surface acting cannot be completely eliminated and thus identifying how to reduce such resource losses is important. In addition to identifying mistreatment-prone units, another important step is to identify a threshold level of mistreat- ment from patients or their families (i.e., zero-tolerance vs. three strikes, specified intensity level) to plan for appropriate interven- tions (Trougakos et al., 2008). For example, an employee could say that they are at that critical threshold and thus obtain a break or switch patient-interactions for other tasks with another em- ployee. Work breaks where one can interact authentically with coworkers “backstage,” (Lewis, 1995) or socially withdraw (Repetti, 1989) should reduce depletion and could be structured around knowing when the surface acting with patients is likely to be highest. Our findings suggest that employees need education and training in effective ways to respond to mistreatment. Em- ployees who were frequently suppressing and faking their emo- tions when interacting with customers were more likely to feel burned out and depleted, even in “caring work” (Brotheridge & Grandey, 2002); in contrast, the use of deep acting strategies such as reappraisal were less likely to have such effects (see Bono & Vey, 2005 for a review). Developing employee efficacy for how to manage emotions, and when (i.e., with patients vs. with cowork- ers) is a critical life skill as well as work skill.

Unit-level climate has been shown to be an important determi- nant of burnout in caring work (Bacharach & Bamberger, 2007; Le Blanc, et al., 2007), and we identify the climate of authenticity as a unit-level variable serving as a buffer against the emotional depletion that results from surface acting. Future research that identifies antecedents to climate of authenticity will be important for workplace decisions that affect climate of authenticity. For example, team composition (e.g., characteristics like gender, team tenure, skill diversity, cultural background, etc.) may influence climate of authenticity by influencing the sense of similarity with members and thus perceived safety to express oneself. Top-down, unit supervisors can influence emotional norms among coworkers, and could encourage authentic expressions rather than maintaining a “positive attitude” (Fineman, 2006; Wilk & Moynihan, 2006). However, institutionalized sharing (e.g., in meetings) where peo- ple are encouraged by management to share negative emotions

10 GRANDEY, FOO, GROTH, AND GOODWIN

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(McCance, et al., in press) may not have recovery effects, since they could simply produce new forms of emotion regulation. A “bottom-up” climate of authenticity that emerges from peers may be more effective. Overall, given that employee burnout is linked to absences, turnover, and performance decrements (e.g., Halbes- leben & Bowler, 2007; Wright & Cropanzano, 1998), helping employees feel “free to be you and me” in a work group can be a critical step in improving employee and organizational well-being.

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(Appendix follows)

13CLIMATE OF AUTHENTICITY AND EMOTIONAL LABOR

Th is

d oc

um en

t i s c

op yr

ig ht

ed b

y th

e A

m er

ic an

P sy

ch ol

og ic

al A

ss oc

ia tio

n or

o ne

o f i

ts a

lli ed

p ub

lis he

rs .

Th is

a rti

cl e

is in

te nd

ed so

le ly

fo r t

he p

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na l u

se o

f t he

in di

vi du

al u

se r a

nd is

n ot

to b

e di

ss em

in at

ed b

ro ad

ly .

Appendix

Mistreatment by Patients and Their Families (Modified From Spector & Jex, 1998)

1. How often did patients or their families argue with you or your team?

2. How often did patients or their families yell at you or your team?

3. How often did patients or their families speak rudely toward you or your team?

4. How often did patients or their families swear at or insult you or your team?

Team Climate of Authenticity (Modified From Edmondson, 1999)

1. If you show anxiety or distress with this team, it is held against you (R).

2. Members of this team are able to discuss how they feel about problems and issues.

3. People in this team reject others for showing irritation or frustration in the team (R).

4. It is safe to show how you really feel with this team. 5. It is uncomfortable for team members to show sadness or

disappointment with each other (R). 6. No one on this team would deliberately act in a way that

disrespects another member’s feelings. 7. Working with members of this team, expressions of feelings

are respected.

Received February 4, 2011 Revision received July 12, 2011

Accepted July 13, 2011 �

14 GRANDEY, FOO, GROTH, AND GOODWIN

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