Through popular culture, we are conditioned to value positive emotions and not only to value them, but on many occasions, place them as superior to negative feelings. Of course, the psychiatric nurses out there will insist that feelings aren’t bad or good, better or worse, they just are. I would advance this idea to reinforce the realization that sometimes we need to feel and express “negative emotions,” such as sadness, grief, loss, psychological trauma, boredom, anxiety, and anger. Furthermore, they are part of a healing process when we encounter hardship and psychological trauma. This thesis has implications for nurses in intrapersonal, interpersonal, and organizational systems.

First, emotions have a purpose. According to Heather Lench, a researcher at Texas A&M University, who studies boredom, anxiety, and anger in her lab, sadness is an emotion that can help people recover from failure. Sadness evokes a thoughtful process where individuals can process information with more accurate memory, judgment and even improved detection of people lying. Anxiety, according to Lench (2024), assists us in perceiving potential threats; it can improve performance and elicit protective behaviors. Last, boredom is helpful in that while our emotions are not prompting an emotional response, boredom can stir us to making a change (Lench, 2024). In summary, both positive and negative emotions are useful tools for us and utilized as needed to help us achieve desired outcomes (Lench, 2024).

Additional lessons can be found no further than the animated children’s film: Inside Out (Docter, 2015). The seventh highest grossing film of 2015, this movie presents a young girl’s sorrow at moving away from her home and city, and the subsequent loneliness and sadness she feels. The resolution of the movie comes when the characters of Joy and Sadness work together to restore balance with the old memories and in the process, create new ones. This is somewhat unexpected as Joy is the primary character throughout the movie. The revelation that Sadness can be valuable is a surprise because throughout the movie, Sadness is a seemingly inconsequential character.

Yet, despite popular culture and science supporting the usefulness of negative emotions, there’s often pushback when we don’t adhere to the cultural norms of positivity. I recall a presenter at the 2024 Virtual Nursing Conference in March who had a compelling presentation on power structures in nursing and healthcare organizations who, during a question-and-answer session, confessed to being told she wasn’t being “positive enough” in her healthcare organization. The individual was left with effectively being shut down and indirectly, but clearly, being blamed for the emotions she was feeling and communicating. Shame on the nurse leader who told her this. I think the latter.

From a conceptual standpoint, my theories address mental health issues such as psychological trauma, parental depression, and substance use and don’t seem quite as popular as those that focus on positive emotions (Foli, 2010; 2019; 2022). Nonetheless, I see my work as incredibly beneficial to improving the human condition. The model that I ascribe to is that of Herman (1999) who clearly outlines the process of recovery from trauma in three stages: establishment of psychological safety, remembering and mourning the loss, and reconnecting with ordinary life. How are we to recover within these stages when we are asked to discount our loss? Our sadness? Our sorrow?  

 However, recent insights offer me a sense that how we view negative feelings is shifting, especially for nurses in practice. For example, a new concept analysis by Shipp and Hall (2024) describes toxic positivity and its three salient dimensions: Emotional suppression, unrealistic optimism, and disingenuous happiness. The first dimension, emotional suppression has two inner themes: logical fallacy and forced gratitude. Exchanges of toxic positivity result in the receiver experiencing negative outcomes (Shipp & Hall, 2024). Shipp and Hall (2024) state: “Within toxic positivity lies an implicit casual logical fallacy that a positive mindset produces positive outcomes…” (p. 4). The authors conclude how future research may improve the epidemic of nurse burnout and result in improved outcomes for nurses.

It appears to me that the presence of toxic positivity blocks Herman’s first and second stages of recovery. In the presence of toxic positivity, how can a nurse hope to feel psychologically safe and mourn the loss of how trauma has affected them? How can we use emotions such as sadness, anxiety, and boredom as tools to move forward when nurses are instructed to feel only positive emotions? Isn’t this a form of unspoken oppression that has influenced nursing for so long?

There is also the existential work of nurses that includes emotional labor (Huynh et al., 2008) and the expression of emotions that appears to be regulated by nurses themselves. In a concept analysis, Huynh et al. (2008) define emotional labor as:

            …a process through which nurses adopt a work persona to express their autonomous, 
            deeply or superficially felt emotions during patient encounters (p. 201). 

The authors explain that nurses’ emotional labor is scripted by the organizations that aim to control nurses’ interpersonal emotions; however, professional identification is more influential than organizational norms (Huynh et al. 2008). In other words, when giving care and comfort, being a nurse is more influential than being part of the organization. Negative consequences of nurses’ emotional labor include “job-related stress, emotional strain, feelings of estrangement from self, burnout, and depersonalization” (Huynh et al., 2008; p. 202). Too often, the components of toxic positivity intersect with nurses’ emotional labor, and it is this intersection, often this absurd disconnect, which result in organizations failing to recognize, value, and honor nurses’ authentic range of emotions often experienced within the patient encounter. 

In the final analysis, by hyper-valuing positive emotions, and ignoring, denying, and belittling negative feelings, nurses are weakened, and nursing care is weakened. Expressing negative emotions doesn’t equate to an individual being a pessimist, a naysayer, or malcontent. Sometimes, those emotions, which are not viewed as positive, are exactly what we need to counter toxic positivity, remember events accurately, detect duplicity, be motivated to change, embrace resilience, and ultimately, to heal and recover from difficult experiences – and deliver the emotional labor of nurses. Denying the existence of the spectrum of emotions distorts reality and the lived experiences as nurses. A balance of emotions, as Lench (2024) describes, allows us to use our feelings as tools to enhance outcomes as we navigate the complexities of life – and may help us retain our talented nurses who give so much in the care they render.    

References

Docter, P. (Director). (2015). Inside Out [Film]. Pixar Animation Studies for Walt Disney Pictures.

Foli, K.J. (2010). Depression in adoptive parents: A model of understanding through grounded
 theory. Western Journal of Nursing Research, 32, 379-400. doi:
10.1177/0193945909351299

Foli, K. J. (2022). Foli, K. J. (2022). A middle-range theory of nurses’ psychological trauma. Advances in Nursing Science, 45(1), 86-98. doi: 10.1097/ANS.0000000000000388

Foli, K. J. & Thompson, J. R. (2019). The influence of psychological trauma in nursing. Sigma Theta Tau International Publishing.

Herman, J. (1999/2015). Trauma and recovery: The aftermath of violence –from domestic abuse to political terror. New York, NY: Basic Books.

Huynh, T., Alderson, M., & Thompson, M. (2008). Emotional labour underlying caring: An evolutionary concept analysis. Journal of Advanced Nursing, 64(2), 195-208. doi: 10.1111/j.1365-2648.2008.04780.x.

Lench, H. (2024, February 14). Anger, sadness, boredom, anxiety – emotions that feel bad can be useful. The Conversation.

Shipp, H. G., & Hall, K. C. (2024). Analyzing the concept of toxic positivity for nursing: A dimensional analysis approach. Journal of Advanced Nursing, 00, 1-12. https://doi.org/10.1111/jan.16057