How team emotion rules impact staff turnover in healthcare

Managing emotional demands in healthcare is critical to staff retention, with research highlighting the impact of display rules on turnover rates

In a busy emergency department at a major children's hospital, staff face intense emotional demands daily – from comforting distressed parents to maintaining calm professionalism during critical incidents. Healthcare teams must navigate complex emotional terrain: maintaining composure while treating critically ill children, projecting warmth and reassurance to anxious families, and managing their own emotional responses to challenging situations. In some departments, like orthopaedics, the emotional context may be less intense. However, in areas such as oncology or emergency care, staff regularly encounter raw emotional situations requiring careful management of their displayed feelings.

This challenge of managing emotions while delivering care emerged as a critical factor in staff retention, according to recent research. With nurses experiencing turnover rates as high as 40% annually in some countries, for example, understanding how team-level emotional expectations affect staff retention has become increasingly important.

New research from UNSW Business School examined how team-level expectations about displaying or suppressing emotions affected turnover rates among 442 healthcare professionals across 72 teams in a major Australian children's hospital. The findings revealed important insights for organisations managing frontline service teams.

The hidden cost of emotional suppression

The research, published in the Journal of Service Research, found that when teams emphasised suppressing negative emotions, it reduced staff members' psychological attachment to their workplace and increased voluntary turnover 12 months later. The study, How Display Rules Influence Turnover in Healthcare Teams and the Moderating Role of Team Negative Affective Tone was conducted by Helena Nguyen and Anya Johnson from the University of Sydney Business School, and Markus Groth, Professor of Organisational Behaviour in the School of Management and Governance at UNSW Business School.

The research team collected data through surveys and tracked actual turnover rates over 12 months. They measured both positive and negative display rules, team emotional context, and psychological attachment among healthcare professionals including nursing, allied health, medical and administrative staff. This comprehensive approach allowed them to examine how different types of emotional expectations affected staff retention across various healthcare contexts.

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Their findings offer valuable insights for organisations seeking to better manage emotional expectations and reduce costly turnover among frontline service staff. "In teams with negative team display rules, this can lead to a secondary resource loss and thus exacerbate the negative impact of team negative display rules on turnover via affective commitment, given that the frequent intensive emotional context drains resources from team members," the researchers explained.

Prof. Groth and his team were interested in this research because understanding how emotional demands for frontline workers impact their wellbeing, engagement, and performance sheds light on the hidden emotional effort employees invest in their roles. This is particularly the case in service industries, where positive interactions are critical to success. “Exploring the balance between authentic emotional expression and organisational expectations helps leaders design healthier workplaces, reduce burnout, and enhance employee engagement,” said Prof. Groth.

Positive team culture drives retention

Interestingly, the study found that teams emphasising positive emotional displays had lower turnover rates. The researchers observed that “simply being in a shared social context where there is a strong emphasis on positive emotions can have self-fulfilling effects and produce positive spirals." These benefits emerged independently of the emotional intensity of the work environment, suggesting that positive display rules serve as a protective factor even in challenging healthcare contexts.

The research demonstrated that when teams encouraged appropriate expressions of positive emotions such as empathy, warmth and compassion, staff were more likely to remain in their roles. "Such detrimental outcomes may be mainly driven by negative display rules. This suggests that negative display requirements indeed have detrimental effects on frontline employees and even more deleterious effects when frontline employees are working in team contexts characterised by heightened negative emotions such as healthcare settings," the researchers noted.

This finding carries significant implications for healthcare organisations, where turnover rates have reached concerning levels. With replacement costs for a single nurse in Australia estimated to be $49,255, addressing turnover through better emotional management practices offers substantial cost savings.

The financial impact extends beyond direct replacement costs. As the researchers explained: "In healthcare, an inability to retain valued healthcare employees has detrimental outcomes for patients, including disruptions to the continuity of care and decreased quality and safety of patient care." Additional costs include increased workload for remaining staff, lost institutional knowledge, and the time required to train new team members.

The study found that positive display rules created opportunities for staff to build rewarding social relationships with patients and colleagues, helping to offset the demanding nature of healthcare work. Rather than forcing artificial cheerfulness, successful teams encouraged genuine expressions of care and compassion that aligned with healthcare professionals' natural motivation to help others.

Practical implications for organisations

The research highlighted several actionable insights for healthcare organisations and other service-focused businesses. As the authors noted, "Rather than lumping the two together, supporting team members to display positive emotions when interacting with patients and creating psychologically safe places that are removed from the frontline (such as supported debriefing after difficult experiences with patients) where frontline employees can express negative emotions may help restore lost motivational resources."

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For leaders managing frontline service teams, the research suggested focusing on creating environments that encourage appropriate positive emotional displays while providing safe spaces for processing negative emotions. As Professor Groth explained: "Leaders can play a role in encouraging and modelling a norm or setting the expectation for positive emotions (appropriate to the context) such as caring, compassion, and kindness, as this will have benefits for patients and for frontline employees in creating more sustainable careers."

While organisations often design display rules for the benefits of customers, Prof. Groth said managers need to carefully balance the needs of customers and employees. “While display rules enhance customer experience, and are primarily designed with that purpose in mind, overly rigid expectations harm employee engagement and satisfaction. Managers must find a balance between meeting customer expectations and preserving employee wellbeing,” he said.

To achieve this balance, Prof. Groth said managers should actively seek employee feedback and adjust emotional display expectations to ensure they are both effective and sustainable. “Prioritising employee wellbeing not only supports retention but also enhances service quality, as engaged and supported employees are more likely to deliver exceptional customer experiences,” he concluded.