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Exploring the impact of surface acting on nurse leaders during COVID

Carlene Joy Boucher (Australian Institute of Business and Management Pty Ltd, Adelaide, Australia)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 13 October 2022

Issue publication date: 4 April 2023




Coronavirus (COVID) has had a massive impact on the health systems of many nations including Australia. Nurse leaders have, as part of their leadership and management roles, had to manage the emotional responses of the people around nurse leaders . The purpose of this study was to explore the experiences of nurse leaders who have held management roles during the health services crisis that has resulted from the COVID pandemic and to look at the emotional work nurse leaders have engaged in and the impact emotional work has had on nurse leaders' emotional well-being.


The study adopted a social constructionist approach and employed unstructured interviews to generate data.


The findings demonstrate that the nurse leaders were experiencing increased emotional exhaustion, which could be construed as a breach of psychological safety, as nurse leaders engaged in more surface acting. This has negatively impacted their lives outside of work. The study recommends that nurse leaders receive support through counselling and reflective practice activities. Consideration also should be given to renumerating nurse leaders appropriately for the emotional work nurse leaders perform.

Research limitations/implications

The structural issues endemic in the industry need to be addressed. Human resource management professionals, senior managers and hospital boards are charged with ensuring that the organisations are safe and healthy workplaces. This includes addressing issues that impact psychological health. If nurse leaders must undertake work that impacts negatively on nurse leaders' mental well-being and personal lives, then appropriate safeguards need to be put in place. The scope of the study was small, as the study is limited by the number of interviewees, the number of study sites and the sites' geographical location. Consequently, limited claims are made about the generalisability of the findings or the findings' transferability to other contexts.

Practical implications

The findings overwhelmingly support the contention that we need to support nurse leaders in the vital role they play through engaging in surface acting in the workplace. The role needs to be recognised and valued as a critical part of the nurse leader role. The contribution the role makes to the welfare of others in the organisation needs to be acknowledged. Given the emotional and personal price that nurse leaders play for surface acting, organisations need to provide genuine support in the form of counselling and the introduction of opportunities for reflective practice.

Social implications

The study suggests that nurse leaders need to be paid for emotional labour (EL) generally and surface acting in particular. The recognition of the value of caring work must go beyond symbols such as the Year of the Nurse and be rewarded financially.


The experience of nurse leaders using surface acting has received little attention and this is the first study to look at this particular phenomenon during COVID.



Boucher, C.J. (2023), "Exploring the impact of surface acting on nurse leaders during COVID", Journal of Health Organization and Management, Vol. 37 No. 1, pp. 1-16.



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