International Journal of Nursing Sciences xxx (2018) 1e7

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International Journal of Nursing Sciences

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nursing-sciences/2352-0132

Original Article

The effects of emotional labor and competency on job satisfaction in

nurses of China: A nationwide cross-sectional survey
Xinjuan Wu a, *, Jiaqian Li a, Ge Liu a, Ying Liu a, Jing Cao a, Zhaoxia Jia b
a
Department of Nursing, Peking Union Medical College Hospital, Beijing, China
b
Department of Health Care, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital,
Beijing, China

a r t i c l e i n f o a b s t r a c t

Article history: Objectives: This study aimed to explore the status of job satisfaction, emotional labour, core compe-
Received 27 November 2017 tencies and job stress and the associations of emotional labour and core competencies with the job
Received in revised form satisfaction of nurses in China.
20 April 2018
Methods: Data were collected by using a self-designed general information questionnaire, a job satis-
Accepted 30 August 2018
Available online xxx
faction questionnaire (McCloskey/Mueller Satisfaction Scale), a nurse emotional labour questionnaire,
the Competency Inventory for Registered Nurses questionnaire, and a nurse job stressor questionnaire. A
total of 13,448 nurses from 92 hospitals across mainland of China were surveyed, and 11,337 respondents
Keywords:
Competency
(84.3% response rate) completed the questionnaires.
Emotional labour Results: The survey results indicated that Chinese nurses had average job satisfaction (24.77 ± 5.23),
Job satisfaction moderate job stress (86.84 ± 21.12), moderate to high emotional labour experiences (55.08 ± 9.63) and
Nurse high competency (195.77 ± 37.61). Multiple linear regression indicated that surface acting was negatively
correlated with job satisfaction (P < 0.01), while deep acting (P < 0.01) and nurses’ core competence
(P < 0.01) were positively associated with job satisfaction. Besides, The results also indicated job stress,
geographical distribution, hospital category, gender, work shift, only children, parenting status, monthly
salary, nursing experience, professional title, hospital area were the influencing factors of job satisfaction
(P < 0.05).
Conclusion: The improvement of the emotional labour and competency of nurses may help enhance their
job satisfaction.
© 2018 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction In China, the demand for quality health care service has greatly
increased in the last two decades, and hospitals are facing chal-
Healthcare workers in hospitals experience high levels of job lenges to provide high-quality service in this rapidly changing
stress and low job satisfaction [1]. Hospital nurses are at high risk environment [10]. A limited number of nurse staff against a
for occupational burnout, reduced job satisfaction and high levels growing patient population and their needs further poses serious
of job stress worldwide, thus leading to poor nursing outcomes challenges to providing quality healthcare service [11]. Low job
[2e4]. Numerous studies have described job stress, satisfaction and satisfaction of nurses has also been reported in China. Lu and col-
burnout among nursing professionals [5e8]. Nantsupawat et al. [4] leagues [12] reported that low salary (79.2%) is the major reason for
reported that 28% of nurses in Thailand are dissatisfied with their nurse job dissatisfaction. A survey conducted in six hospitals in
job. Aiken and colleagues [9] reported that job dissatisfaction Harbin, China, showed that nurses were dissatisfied mainly for
among nurses varied from 17% to 60% in nine sample countries. The workload and compensation reasons [13]. Liu and colleagues [14]
work environment is an important factor that substantially con- reported that more than 50% of nurses were dissatisfied with their
tributes to nurses’ job dissatisfaction [9]. job in Guangdong Province, China. The results of studies and sur-
veys conducted in China varied widely because of the different sites
of selection and the use of various measurement instruments.
* Corresponding author.
The clinical competency of nurses is an important factor
E-mail address: wuxinjuan@sina.com (X. Wu).
Peer review under responsibility of Chinese Nursing Association.
affecting job satisfaction. A previous study demonstrated that the

https://doi.org/10.1016/j.ijnss.2018.08.001
2352-0132/© 2018 Chinese Nursing Association. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
2 X. Wu et al. / International Journal of Nursing Sciences xxx (2018) 1e7

core competencies of nurses correlated significantly with job Quality control was performed in two ways. (1) To ensure
satisfaction, stress, burnout and turnover [7]. In addition, emotional questionnaire completion, each item was set as a required question,
labour, which is required in the nursing profession, may also reduce which could not be left unanswered. (2) Each enrolled nurse was
job satisfaction. In the 1980s, Arlie Russell Hochschild introduced assigned a username and a password, which allowed detection of
the concept of ‘emotional labour’, referring to the management of a non-responding nurses, who were followed up by their respective
person's inner emotions to meet the requirement of emotional centres.
expression of an organisation. The management of personal
emotion to fulfil job requirements is essential in the nursing pro- 2.3. Measurement tools
fession. However, to date, only a limited number of studies have
related the parameters of nurses' job satisfaction with the status of All the participants received questionnaires, including a self-
emotional labour in China. designed general information questionnaire, the McCloskey/
The present study aimed to explore the status of emotional la- Mueller Satisfaction Scale (MMSS), a nurse emotional labour
bour, core competencies, job satisfaction and stress of nurses in questionnaire, the Competency Inventory for Registered Nurses
tertiary hospitals in mainland of China. In addition, the associations (CIRN) and a nurse job stressor questionnaire. The developers
of emotional labour and core competency with job satisfaction permitted usage of all questionnaires in this study.
were analysed.
2.3.1. General information questionnaire
2. Methods The self-designed general information questionnaire consisted
of questions pertaining to age, gender, marital status, education,
2.1. Study design work experience, employment status, hospital area, professional
title.
The present study was a nationwide, multi-centre, cross-
sectional survey. From April 2015 to July 2015, a selected sample 2.3.2. MMSS
population of nurses from 92 hospitals across the mainland of The job satisfaction was measured using the MMSS [16]. This
China was surveyed with online questionnaires for general infor- scale is used in determining whether the nurses were satisfied with
mation, job satisfaction, emotional labour, core competency and job their profession by assessing 31 items in 8 dimensions, including
stress. For this online survey, unique usernames and passwords satisfaction with extrinsic rewards, scheduling, family/work bal-
were established for each included nurse. The web links were then ance, co-workers, interaction, professional opportunities, praise/
sent to the charge nurses in the hospitals and then assigned to the recognition, and control/responsibility. Responses were rated on a
individual nurses. The data were collected and analysed for 5-point Likert scale ranging from ‘very satisfied’ (5 points) to ‘very
measuring the general status of job satisfaction, stress, emotional unsatisfied’ (1 point). The reported Cronbach's a coefficients of the
labour, competency and the potential interactions between these total scale were 0.89. The questionnaire was translated and modi-
factors. The ethics committees of all 92 participant hospitals fied to generate a Chinese version by Zheng et al [5]. The cumulative
approved the study, and the survey form included a clear statement range of variance of the Chinese version of the MMSS for the
that the subjects used to provide informed consent for their different items was 0.80e1.0, with an average of 0.94. The reported
participation in the survey. Cronbach's a coefficient of the total scale was 0.95; the coefficients
for the dimensions were 0.84, 0.89, 0.70, 0.64, 0.70, 0.85, 0.87 and
2.2. Study population and sampling method 0.85.

According to China's ‘Comprehensive Hospital Evaluation Stan- 2.3.3. Nurse emotional labour questionnaire
dards and the Implementation Rules’, which contains 6 basic The Chinese version of this questionnaire was developed by Luo
standards and 48 core items, hospitals in the country are catego- and Sun [17] on the basis of the emotional labour scale designed by
rized into 3 Grades and 10 levels. Tertiary hospitals, which require Grandey [18]. This questionnaire aims to increase the under-
more than 500 beds, provide the highest level of medical and standing of the emotional status of nurses on task by accessing
nursing care in China [15]. Nurses working in these hospitals were emotional labour at three dimensions, including surface acting
invited to participate in the survey. The inclusion criteria were as (items 1e7), requirement to express emotions (items 8e11) and
follows: expression of willingness to participate in the survey by deep acting (items 12e14). Surface acting involves ‘pretending’ to
the signing of the informed consent at the time of username and feel one emotion while feeling another, whereas deep acting is
password assignment by the charge nurses; and permanent or comparatively effortless and requires changes in the internal
contract employment with the surveyed hospitals. The exclusion emotions to align these with the expected emotions, thus making
criteria were the following: unavailability on the survey date (e.g. the feeling appear genuine. Each item was rated on a 6-item scale
off-duty and leaves due to illness, maternity, personal reasons, ranging from ‘extremely disagree’ (1 point) to ‘extremely agree’ (6
training and business trips). Interns and/or nurse students were point). The cumulative variance of the three dimensions was
also excluded. Stratified cluster sampling was adopted to recruit the 62.78%. The Cronbach's a coefficients of the three dimensions were
participants in this survey. According to 2013 statistics from the 0.711, 0.826 and 0.872, and that of the total scale was 0.811, indi-
Ministry of Health of the People's Republic of China, 989 tertiary cating optimal reliability and validity.
hospitals were in mainland of China, whereas 438, 317 and 234
were in the eastern, middle and western regions, respectively. In 2.3.4. CIRN
the present study, 10% of the hospitals in each region were Nurses' core competencies, which comprise an issue of care
randomly selected and invited for participation. In each respondent quality and ensuring competence in terms of ability and actual
hospital, 10% of all the nurses were randomly selected from the performance, are legal and ethical obligations to individual
departments of internal medicine, surgery, obstetrics and gynae- healthcare recipients and payers. CIRN was developed by Liu et al
cology, paediatrics, ENT, outpatient and emergency and surgical [19] as an objective tool for measuring the competencies of regis-
supply, which were the major departments in most of the surveyed tered nurses in the different areas of clinical practice. The ques-
hospitals and represented a large number of nurses. tionnaire consists of 55 items (i.e. competencies) divided into 7

Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
 X. Wu et al. / International Journal of Nursing Sciences xxx (2018) 1e7 3

dimensions, clinical care (10 items), leadership (9 items), inter- emotional labour and core competency. The statistical significance
personal relationships (8 items), legal/ethical practice (8 items), was set at P < 0.05. In addition, job stress and the general charac-
professional development (6 items), training/consultation (6 items) teristics of the participants were regarded as risk-adjusting vari-
and critical thinking/research ability (8 items). Each item was rated ables in the multiple linear regression.
on a 4-point scale ranging from ‘no competency’ (0 point) to ‘high
competency’ (4 point). Overall competency was evaluated at three
3. Results
levels: a total score <110 denoted low competency, 110e165
signified moderate competency and 165e220 demonstrated high
A total of 13,448 nurses in 92 hospitals were invited to partici-
competency. The reported Cronbach's a coefficient of the total scale
pate in this survey. Among them, 11,337 respondents (84.3%
was 0.893. The reported coefficients of the seven dimensions
response rate) completed the questionnaires. The geographical
ranged from 0.79 to 0.86, whereas the validity was measured as
distribution of the surveyed hospitals is illustrated in Table 1.
r ¼ 0.44 (P < 0.05).
Table 2 shows that 47.44% nurses were from east China, while
32.04% came from central China and 20.53% came from west China.
2.3.5. Nurse job stressor questionnaire The nurses were working mostly in comprehensive hospitals
The nurse job stressor questionnaire was developed in Chinese (94.30%) and general wards (68.71%). The survey results indicated
by Li and Liu [8] on the basis of the nursing stress scale developed that most of the nurses (96.44%) were female and held at least a
by Wheeler and Riding [20]. The questionnaire consists of five di- bachelor's degree (66.34%). A total of 54.45% of the nurses were
mensions, namely, professional and work issues (items 1e7), work 20e29 years old, while 31.13% were aged 30e39. In total, 63.68% of
load and time allocation issues (items 8e12), working condition the nurses had been working for less than 10 years, and 76.49%
and resource issues (items 13e15), issues in patient care (items were nurses or nurse practitioners. Most of the nurses (64.45%)
16e26) and issues in personal relations and management (items were contract employees, and 69.04% worked in shifts. Most of
27e35). Each item was rated on a 4-point scale representing ‘no these nurses were married (63.79%), and most weren't an only
pressure’ (1 point) to ‘high pressure’ (4 point). The total stress scale children (68.73%). Approximately half of the nurses (52.06%) had
was evaluated at three levels: 35e75 as light stress, 76e105 as children, and only 27.64% of the nurses earned more than ¥6000
moderate stress and 106e140 as high stress. The reported Cron- per month. In terms of job satisfaction, significant statistical dif-
bach's a coefficients of the questionnaire were 0.98 for the total ferences were found among the participating nurses (P < 0.001).
stressor scale, 0.95 for professional and work issues, 0.83 for work The job satisfaction survey (Table 3) results demonstrated an
load and time allocation issues, 0.92 for working condition and average job satisfaction among the nurses (24.77 ± 5.23), with the
resource issues, 0.94 for issues in patient care and 0.90 for issues in least satisfaction on income and benefits (2.65 ± 0.92) and balance
personal relations and management. This questionnaire is between work and family (2.83 ± 0.99).
commonly used to measure the job stressors of clinical nurses in The survey results (Table 4) indicated moderate to high
China. emotional labour experiences (55.08 ± 9.63). The deep acting
dimension scored (4.95 ± 0.81), the requirement to express emo-
2.4. Statistical analysis tions dimension scored (3.91 ± 1.02) and the surface acting
dimension scored (3.52 ± 0.92).
Statistical analysis was performed using the software SPSS 18.0 The deep acting instrument appeared to be more significant
(IBM, Chicago, IL, United States). Descriptive statistics were used to than surface acting and requirement to express emotions.
present the measurement status of job satisfaction, stress, Most of the nurses (81.13%) surveyed had high competency.
emotional labour, competency and the general status of the sur- Approximately a fifth of the surveyed nurses (17.91%), corre-
veyed nurses. Continuous variables were expressed as Mean ± SD. sponding to 2009 subjects, had moderate competency and only 107
Categorical variables were expressed as numbers and percentages. nurses (0.95%) exhibited low potency. Moreover, the score of the
The comparison of classification variables was measured using the job stressor questionnaire was (86.84 ± 21.12), which indicated
t-test and ANOVA, and the comparison of continuous variables was moderate stress levels among the surveyed nurses (Table 4).
measured using Pearson's correlation. Multiple linear regression Tables 5 and 7 indicate the relationships of nurse job satisfaction
was used to examine the relationship of job satisfaction with with emotional labour, CIRN and job stress. The results indicated a

Table 1
Geographical distribution of surveyed hospitals (n ¼ 92).

Province/City Number of tertiary hospitals Number of sampled tertiary hospitals Province Number of tertiary hospitals Number of sampled tertiary hospitals

Beijing 37 5 Jiangxi 42 4
Tianjin 22 3 Henan 46 4
Hebei 37 4 Hubei 49 3
Liaoning 50 5 Hunan 31 3
Shanghai 29 1 Inner Mongolia 16 2
Jiangsu 51 4 Chongqing 15 3
Zhejiang 52 5 Guangxi 41 2
Fujian 27 3 Sichuan 53 5
Shandong 46 4 Guizhou 24 2
Guangdong 78 7 Yunnan 9 1
Hainan 9 1 Shaanxi 31 3
Shanxi 33 2 Gansu 18 1
Jilin 25 3 Qinghai 9 1
Heilongjiang 61 5 Ningxia 3 2
Anhui 30 3 Xinjiang 13 1

Note：The sampled hospitals were randomly selected from tertiary hospitals of each province in the mainland of China.Total number of tertiary hospitals ¼ 987; Total number
of sampled tertiary hospitals ¼ 92.

Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
4 X. Wu et al. / International Journal of Nursing Sciences xxx (2018) 1e7

Table 2
Job satisfaction scores of nurses with different characteristics (n ¼ 11,337).

Variables n (%) Score (Mean ± SD) t or F P

Geographical distribution
Eastern region 5378 (47.44) 24.76 ± 5.32 24.55 <0.001
Central region 3632 (32.04) 25.14 ± 5.28
Western region 2327 (20.53) 24.17 ± 4.86
Hospital category
Comprehensive 10692 (94.30) 24.68 ± 5.20 6.65 <0.001
Specialized 645 (5.70) 26.14 ± 5.43
Gender
Male 404 (3.56) 23.26 ± 5.01 5.90 <0.001
Female 10933 (96.44) 24.82 ± 5.23
Age (years)
20e29 6173 (54.45) 24.56 ± 5.24 45.04 <0.001
30e39 3530 (31.13) 24.61 ± 5.18
40 1624 (14.32) 25.90 ± 5.13
Nursing experience (years)
0e4 3849 (33.95) 24.51 ± 5.19 27.46 <0.001
5e9 3370 (29.73) 24.57 ± 5.31
10e19 2444 (21.55) 24.71 ± 5.13
20 1674 (14.77) 25.82 ± 5.16
Education
College degree 3816 (33.66) 24.80 ± 5.22 0.48 0.634
Bachelor's degree or higher 7521 (66.34) 24.75 ± 5.23
Professional title
Nurse 3720 (32.81) 24.64 ± 5.20 50.01 <0.001
Primary nurse 4952 (43.68) 24.40 ± 5.28
Nurse-in-charge and above 2665 (23.51) 25.63 ± 5.07
Hospital area
General ward 7790 (68.71) 24.92 ± 5.32 15.19 <0.001
Critical care ward 1190 (10.50) 23.84 ± 5.08
Outpatient or emergency department 1462 (12.90) 24.65 ± 5.07
Operation room 895 (7.89) 24.85 ± 4.72
Employment
Permanent 4030 (35.55) 25.18 ± 5.31 6.28 <0.001
Contract 7307 (64.45) 24.53 ± 5.17
Position
Nurse 9820 (86.62) 24.58 ± 5.21 9.58 <0.001
Head nurse or superintendent 1517 (13.38) 25.96 ± 5.19
Work shift
Working in shifts 7827 (69.04) 24.27 ± 5.24 15.24 <0.001
Daytime 3510 (30.96) 25.87 ± 5.04
Marital status
Single 3998 (35.27) 24.47 ± 5.19 10.40 <0.001
Married 7232 (63.79) 24.93 ± 5.25
Others 107 (0.94) 24.61 ± 4.60
Only child
Yes 3545 (31.27) 25.27 ± 5.36 6.87 <0.001
No 7792 (68.73) 24.54 ± 5.15
Parenting status
With child 5902 (52.06) 25.03 ± 5.22 5.58 <0.001
No child 5435 (47.94) 24.48 ± 5.22
Monthly salary (Yuan)
< 4000 3378 (29.80) 23.87 ± 5.05 101.14 <0.001
4000e6000 4825 (42.56) 24.78 ± 5.14
>6000 3134 (27.64) 25.70 ± 5.38

Table 3
Survey results of MMSS questionnaire (n ¼ 11,337).
Table 4
Items Score (Mean ± SD) Survey results of emotional labour, CIRN and job stressor questionnaires
(n ¼ 11,337).
Dimension IV: Co-workers 3.68 ± 0.68
Dimension VII: Praise/recognition 3.62 ± 0.66 Items Score (Mean ± SD)
Dimension VIII: Control/responsibility 3.24 ± 0.71
Emotional labour
Dimension VI: Professional opportunities 3.09 ± 0.77
Surface acting 3.52 ± 0.92
Dimension II: Scheduling 3.00 ± 0.86
Requirement to express emotions 3.91 ± 1.02
Dimension V: Interaction 3.00 ± 0.81
Deep acting 4.95 ± 0.81
Dimension III: Family/work balance 2.83 ± 0.99
Total score 55.08 ± 9.63
Dimension I: Satisfaction with extrinsic rewards 2.65 ± 0.92
CIRN score 195.77 ± 37.61
Total 24.77 ± 5.23 Job stress score 86.84 ± 21.12

Note:MMSS:the McCloskey/Mueller Satisfaction Scale. Note:CIRN:the Competency Inventory for Registered Nurses.

Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
 X. Wu et al. / International Journal of Nursing Sciences xxx (2018) 1e7 5

Table 5 Table 7
Correlation of nurse job satisfaction with emotional labour, CIRN and job stress Multiple linear regression of factors of job satisfaction (n ¼ 11, 337).
(n ¼ 11,337).
Variable B SE b t P
Item Job satisfaction
Constant 28.95 0.57 e 51.18 <0.001
r P Surface acting 0.36 0.04 0.06 9.09 <0.001
Deep acting 0.29 0.04 0.05 6.80 <0.001
Emotional labour dimensions
CIRN 0.25 0.01 0.23 32.25 <0.001
Surface acting 0.317 <0.001
Job stress 0.99 0.01 0.58 80.70 <0.001
Requirement to express emotions 0.106 <0.001
Geographical distribution
Deep acting 0.175 <0.001
Western region 0.18 0.09 0.01 1.98 0.048
CIRN 0.414 <0.001
Hospital category
Job stress 0.690 <0.001
Specialized 0.70 0.14 0.03 4.85 <0.001
Note:CIRN:the Competency Inventory for Registered Nurses. Gender
Female 0.59 0.18 0.02 3.22 0.001
Nursing experience (years)
negative correlation of job satisfaction with surface acting 5e9 0.34 0.10 0.03 3.31 0.001
(b ¼ 0.06, P < 0.001) and with job stress (b ¼ 0.58, P < 0.001). 10e19 0.47 0.13 0.04 3.50 <0.001
The results also showed that job satisfaction was positively related Professional title
0.30 0.03 3.24
to deep acting (b ¼ 0.05, P < 0.001) and CIRN (b ¼ 0.23, P < 0.001). primary nurse 0.09 0.001
Hospital area
Furthermore, although the requirement to express emotions Critical care ward 0.52 0.11 0.03 4.69 <0.001
seemed to be negatively correlated with job satisfaction Work shift
(r ¼ 0.106, P < 0.001) (Table 5), no statistical significancy was Daytime 0.58 0.08 0.05 6.81 <0.001
found in the multiple linear regression (t ¼ 1.780, P ¼ 0.075). Be- Only child
No 0.29 0.07 0.03 4.01 <0.001
sides, The results also indicated job stress, nurses from western
Parenting status
region, specialized hospitals, female, daytime shift, nurses who No child 0.21 0.09 0.02 2.31 0.021
were only children, who have child, higher salary, nursing experi- Monthly salary(yuan)
ence (5e19 years), primary nurses, working in critical care wards 4000e6000 0.43 0.08 0.04 5.25 <0.001
>6000 0.83 0.09 0.07 8.85 <0.001
were the influencing factors of job satisfaction (P < 0.05) (see
Table 6). Note: R2 ¼ 0.55, F ¼ 659.89, P < 0.001. CIRN:the Competency Inventory for Regis-
tered Nurses.

4. Discussion
The present study revealed moderate to high emotional labour
The present cross-sectional survey aimed to explore the status experiences among the surveyed nurses. According to Gabriel et al.
of nurses’ emotional labour, core competencies, job satisfaction and [23], emotional labour should be considered a dynamic integration
stress and the interacting relationships between these factors in of three components, namely, emotional requirements, emotion
tertiary hospitals located in mainland of China. regulation and emotion performance. The nursing profession re-
The findings demonstrated that the Chinese nurses had average quires substantial emotional labour [24,25] due to the 1) social
job satisfaction and notably experienced stress that was directly representation of nurses and 2) constant management and sup-
related to working and professional issues. Specifically, low income, pression of real feelings. Nurses play different emotional roles in
heavy work load, opportunities for interaction and experiences of their profession, including the expression of commitment, support
night shifts were the key factors leading to job dissatisfaction in and emotional care for their patients. In addition, nurses sympa-
Chinese nurses. Similar findings have been reported in various thize with patients and their relatives. The emotional dissonance
countries. In Saudi Arabia, nearly 50% of nurses were found to be between real and displayed emotions may negatively influence
overworked and unsatisfied with their limited incomes. An Italian other aspects of the nurses' well-being and cause alienation, cyni-
report revealed an association of workfamily conflict with job cism, depression and moral distress [26]. Moreover, our survey
satisfaction [21]. A Swedish study agreed with these works and demonstrated that surface and deep acting were negatively and
reported that nurse assistants with positive and caring work cli- positively correlated, respectively, with job satisfaction. Emotional
mates and attitudes towards their leaders experienced enhanced labour may affect the performance of nurses and manifest through
job satisfaction while receiving institutional and environmental poor commitment, low job satisfaction, negative performance and
support [22]. high attrition rates [27]. Therefore, emotional labour might

Table 6
Assignment method of independent variables.

Independent variable Assignment method

Geographical distribution Eastern region ¼ 0, 0; Central region ¼ 1, 0; Western region ¼ 0, 1

Hospital category Comprehensive ¼ 0, Specialized ¼ 1
Gender Male ¼ 0, Female ¼ 1
Age (years) 20e29 ¼ 0,0; 30e39 ¼ 1,0; 40 ¼ 0,1
Nursing experience (years) 0e4 ¼ 0,0,0; 5e9 ¼ 1,0,0; 10e19 ¼ 0,1,0; 20 ¼ 0,0,1
Professional title Nurse ¼ 0,0; Primary nurse ¼ 1,0; Nurse-in-charge and above ¼ 0,1
Hospital area General ward ¼ 0, 0, 0; Critical care ward ¼ 1, 0, 0; Outpatient or emergency department ¼ 0, 1, 0; Operation room ¼ 0, 0, 1
Employment Permanent ¼ 0, Contract ¼ 1
Position Nurse ¼ 0, Head nurse or superintendent ¼ 1
Work shift Working in shifts ¼ 0, Daytime ¼ 1
Marital status Single ¼ 0,0; Married ¼ 1,0; Others ¼ 0,1
Only child Yes ¼ 0, No ¼ 1
Parenting status With child ¼ 0, No child ¼ 1
Monthly salary (Yuan) <4000 ¼ 0,0; 4000e6000 ¼ 1,0; >6000 ¼ 0,1

Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
6 X. Wu et al. / International Journal of Nursing Sciences xxx (2018) 1e7

positively and negatively affect the well-being of nurses. Through Funding

an evaluation of employees in China, Wang and co-workers [28]
concluded that genuine emotion expression promoted job None declared.
engagement and ethical leadership controlled the association of
pretension with job engagement. The findings of this study agreed Appendix A. Supplementary data
with those of the current work. Hence, to increase job satisfaction,
nurses’ deep acting of their emotions should be improved and Supplementary data related to this article can be found at
surface acting should be managed appropriately. These findings https://doi.org/10.1016/j.ijnss.2018.08.001.
suggested that proper control of emotions by nurses would
enhance job satisfaction. Nursing courses and professional training
programs should increase focus on the following to deal with the References
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Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001
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Please cite this article in press as: Wu X, et al., The effects of emotional labor and competency on job satisfaction in nurses of China: A
nationwide cross-sectional survey, International Journal of Nursing Sciences (2018), https://doi.org/10.1016/j.ijnss.2018.08.001