Corps de l’article


Many areas of practice in health and social services are emotionally demanding, for example, child protection services (Jauvin, Freeman and Côté, 2019). In such areas, an elevated emotional demand is associated with a fragile clientele (Conrad and Kellar-Guenther, 2006; Stansfeld et al., 2013). The work in that sector is characterized not only by frequent exposure to traumatic events, such as child abuse and neglect (Osofsky, 2011), but also by an omnipresent risk of physical and psychological abuse from clients (Geoffrion and Ouellet, 2013; Institut de la statistique Québec, 2018; Laporte, 2007; Nadeau, 2010). Such situations are frequently exacerbated by insufficient resources to cope with the demand (Astvik and Melin, 2013; Gamassou and Moisson-Duthoit, 2012; Tham and Meagher, 2009). In sum, emotionally demanding work is characterized by the presence of high emotional demands, the effects of which are magnified by insufficient resources to deal with them (Bolduc et al., 2013; de Jonge and Dormann, 2003). The potential negative consequences experienced by workers in such contexts, for example, burnout, absenteeism and turnover, have been increasingly documented (Harvey et al., 2017; Jauvin et al., 2019; Lizano and Barak, 2012).

Middle managers, whose responsibilities include the overall coordination of their staff’s tasks and the provision of support for carrying them out, have a key role to play in reducing the risks of psychological health problems because of their direct link with those workers (Lewis, Yarker and Donaldson-Feilder, 2012; Nielsen, 2013; Skakon et al., 2010). Although many managers recognize the importance of providing adequate support, attaining this objective is not necessarily straightforward (Côté and Denis, 2018). Middle managers frequently have to juggle this support role with that of multiple, and occasionally incongruent, other responsibilities, for example, setting and evaluating performance objectives, introducing new requirements and procedures and respecting budget limits (Bolduc and Baril-Gingras, 2010; Ericson-Lidman and Strandmerg, 2009; Rivière, Commeiras and Loubes, 2013). As well, their daily work is often characterized by multiple interruptions (Mintzberg, 1989; Skagert et al., 2008). Such challenges can be exacerbated in health and social care organizations by the frequent reforms that have been carried out (Briggs, Cruickshank and Paliadelis, 2012; Figueroa et al., 2019). Thus, the demands and constraints with which many middle managers are confronted can make it challenging to successfully juggle their role of providing support to their staff with their other responsibilities (Bolduc and Baril-Gingras, 2010; Desmarais and Abord de Chatillon, 2010; Rivière et al., 2013; Skagert et al., 2008). Although the importance of providing such support is recognized (Lewis et al., 2012; Paillé, Grima and Bernardau, 2013; Sargent and Terry, 2000; Skakon et al., 2010; van Vegchel et al., 2004) and some of the strategies used by managers to support their staff have been documented (Desmarais and Abord de Chatillon, 2010; Ericson-Lidman and Strandmerg, 2009; Lewis et al., 2012; Sherman et al., 2007; Skagert et al., 2008), little is known about how middle managers specifically endeavour to support their staff in the context of emotionally demanding work.

To analyze the activities of middle managers, we used an ergonomic perspective to focus on understanding real work in situ (Darses and Montmollin, 2012; Guérin et al., 2007). Our research aim was to identify the strategies used by these individuals to support staff whose work is considered emotionally demanding. We chose this theoretical perspective because, among other reasons, ergonomics is keenly interested in the central role of people who are in charge of immediate supervision, that is, not only their activities, their available resources and the constraints they encounter but also their strategies to get their subordinates and, more broadly, the collective work group, to perform the assigned tasks (Caroly and Barcellini, 2013). An ergonomic perspective is appropriate in this investigation because it takes into account not only psychosocial risks but also context, constraints and productivity goals that cannot be ignored.

Materials and Methods

Study design

We used a qualitative descriptive study design (Sandelowski, 2000), which was appropriate for identifying the strategies employed by middle managers to support their staff.

Study setting, recruitment and sample

The findings that we report in this article are one component of a broader investigation: a mixed-methods intervention study carried out from 2013 to 2018 in a regional child protection service in the province of Quebec (Canada) (Jauvin et al., 2019). The mandate of this service is to provide youth who have experienced serious difficulties, and their families, with specialized help. The research project was developed in response to a request from the centre’s health and safety committee, which was concerned about the repercussions of emotionally demanding work on the psychological health of workers and wanted to be supported in the implementation of a preventive strategy. This broader project, which was carried out with a cross-section of staff (support staff, educators, professionals, managers), had three objectives: a- identify the risk and protective factors at the centre; b- develop interventions to reduce the risk factors; and c- evaluate the implementation process and the impacts of the interventions.

Although the broader research project was concerned as much with staff in direct contact with clients as with their middle managers, our focus in this article is on the latter group. The research project received ethical approval (# 2013-2014-10) from the Research Ethics Committee of the Centres de santé et de services sociaux de la Vieille-Capitale, de Québec-Nord, de Portneuf, de la Direction de Santé publique de la Capitale-Nationale et du Jeffery Hale-St Brigid’s.

An initial information letter about the broader project was distributed to the various work sites within the organization, including the middle managers. Subsequently, a senior manager verbally explained the project to the latter individuals. A second information letter specifically about recruitment for the focus groups was subsequently sent to the middle managers. Individuals who were interested in participating contacted the research team.

To be eligible, the participants had to be supervising staff who worked directly with clients. Middle managers were not eligible to participate if they were on leave from work for a period longer than three months. We applied this criterion consistently to gain a picture of the work context that would be accurate, current and thus in line with our research objectives. Consistent with the purposeful sampling approach that we used (Patton, 2015), we endeavoured to ensure that the participating individuals were representative of all sectors of the organization (rehabilitation/accommodation sector; 2nd-line teams, i.e., outpatient rehabilitation and family support resources; security sector), had varying levels of experience and included both men and women.

Data Collection

The broader research project was carried out in three phases: a- the develop- ment phase, during which concrete intervention goals were identified based on the results from the qualitative (individual interviews and focus groups) and quantitative (anonymous questionnaire) inquiries; b- the implementation phase, during which the selected interventions were put in place; and c- the assessment phase, during which the effects of the intervention approach were assessed.

In the context of the first phase, we conducted six focus groups (from 2 to 2.5 hours in duration) between September and December 2013. The aim was to explore how the workers performed their roles. Four of the focus groups included middle managers; three of these groups included managers (one, four and three managers respectively) and staff, and the fourth group included only managers (six). Three managers participated in two of the focus group discussions. We used focus groups because of their advantage in enhancing data quality as a function of the interactions among participants and in helping to clarify the extent to which there is a relatively consistent, shared view or a great diversity of views (Patton, 2015). We used a semi-structured interview guide that elicited the following elements: roles of the participants in the organization; characteristics of the work milieu; challenges; and individual and interpersonal strategies to confront the challenges. With the participants’ consent, we audiotaped the focus group discussions.

Data Analysis

The analysis of the focus group data, carried out by the first three authors, was deductive in the sense that its starting point was an ergonomic perspective. However, we subsequently analyzed the focus group data using an inductive thematic analysis, with the aim of identifying links between the key themes that emerged from the analysis and the research objective following a categorization process (Miles, Huberman and Saldaña, 2014). The analysis included the following stages: transcription of the interviews; general familiarization; identification of the main themes congruent with the ergonomic approach; coding of the data; revision, description and linking of categories for the codes; and validation of the analysis. The last stage involved presenting and discussing a summary of the analysis with representatives of senior and middle managers, the two unions with members in the organization, and human resources. This group of representatives concluded that the findings appeared to capture their reality adequately, and suggested no changes.

Consistent with qualitative inquiry, we adhered to several criteria to create authenticity in our investigation (Lincoln and Guba, 1985), including inductive data analysis, analysis of records (e.g., decision trail, decision rules), audiotaping/verbatim transcription for content accuracy, peer audit to confirm coherence, member checking, and participants’ actual quotations (without using their real names) to provide a thick description of their experiences.


A summary of the 11 participants’ profiles is provided in Table 1. Although the participating middle managers were representative of the various sectors in the youth protection centre, we have not provided the precise numbers. Given the relatively small number of participants and the sensitive nature of the data, there is a risk of compromising the respondents’ anonymity. The study excluded managers on leave from work for a period longer than three months.

Table 1

Participants’ profile

Participants’ profile

* G . McGivern, G. Currie, E. Ferlie, L. Fitzgerald and J. Waring (2015) “Hybrid Manager-Professionals’ Identity Work: The Maintenance and Hybridization of Medical Professionalism in Managerial Contexts.” Public Administration, 93 (2), 412-432, <doi:10.1111/padm.12119>.

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The findings that emerged from our thematic analysis fall into four areas: 1- the range of support strategies; 2- support strategies on two axes; 3- factors influencing the choice of strategy; and 4- time pressure and the need to prioritize. The following sections will cover each of the areas.

Support Strategies

The middle managers used a range of support strategies, which we grouped into seven categories. The categories, and examples of the precise actions taken within them, are summarized in Table 2. Although distinct, the categories were complementary, being used either individually or in combination. As well, not all strategies were used to the same degree or by all of the managers necessarily. For example, providing emotional support (e.g., listen carefully) was a common strategy.

Table 2

Support strategies

Support strategies

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Strategies on Two Axes

After a second level of analysis of the seven strategies identified by the middle managers, we concluded that they could be plotted on two axes, proximity and time, as illustrated in Figure 1.

Figure 1

Plotting of support strategies on proximity and time axes

Plotting of support strategies on proximity and time axes

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With respect to the proximity axis, some of the strategies identified can be classified more as direct support, that is, as direct support by managers to staff. Some other strategies can be classified as being more indirectly supportive; staff were not necessarily even aware of them. For example, providing emotional support to a staff member is direct support while strategically forming teams to take into account the members’ characteristics is a good illustration of indirect support. The various support strategies can be placed at various points on the proximity (direct-indirect) continuum.

With respect to the time axis, some strategies appear to be more short-term in nature with a view to meeting a specific need or longer term in order to bring about a more comprehensive and lasting change. For example, a manager typically provides direct clinical support to meet an immediate need, without necessarily envisaging a longer-term development goal. At the other end of the continuum, a manager typically makes representations to senior managers about employees’ working conditions to achieve a longer term and sustainable goal. As with the proximity axis, the various strategies can be placed at different points on the short- versus long-term continuum.

Plotting the various strategies and their relative frequency on the two axes reveals a preponderance of more direct and short-term strategies. This observation does not exclude the possibility that certain interventions in response to immediate needs might also have a longer-term benefit for employee well-being. However, the trigger for using a strategy is frequently an immediate problem followed by a strategy with a primarily short-term objective.

Factors Influencing the Choice of Strategies

Our analysis also revealed a set of organizational, interpersonal (between individuals and between groups of individuals) and individual factors that seem to influence the managers’ choice of strategies. Some factors seem to act either as facilitators or as constraints for the support that the managers provide their staff. Similar to the support strategies, not all factors, whether facilitating or constraining, were identified as being present on all teams or with all managers. In the following sections, we will describe the three different categories of factors.

Organizational Factors

As summarized in Table 3, managers identified several factors related to work organization that facilitate or constrain how middle managers can support staff. The factors can be placed in order from the macro level (e.g., organizational culture) to the meso (e.g., team structure) and micro (e.g., middle manager aptitudes) levels.

Table 3

Organizational factors that facilitate or constrain middle manager support

Organizational factors that facilitate or constrain middle manager support

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Some of the constraints may simply reflect lack of access or limited access to the facilitators mentioned. Others, however, are hindering factors in their own right, for example, the nature of the hierarchical relationships within the organization.

Interpersonal Factors

The interviews also revealed that certain interpersonal factors in the workplace, as summarized in Table 4, can facilitate or constrain the support strategies adopted by managers. As with Table 3, the factors can be placed on a macro- to micro- continuum.

The availability of the facilitating factors can vary across teams.

Individual Factors

Lastly, certain factors that are related more specifically to the individual characteristics of middle managers can facilitate or constrain how their work is carried out and influence the support strategies that they use, as summarized in Table 5.

Table 4

Interpersonal factors that facilitate or constrain middle manager support

Interpersonal factors that facilitate or constrain middle manager support

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Time Pressure and the Need to Prioritize

Each of the factors that we have identified can to some extent influence how middle managers support their staff. However, the influence of a particular organizational factor, i.e., insufficient time available to complete all tasks, appeared more prominent in the managers’ discourse. This element also interacts with a range of other factors that have been mentioned, for example, budget constraints, accountability obligations, management and employee expectations, which lead to a need for managers to prioritize their activities. Indeed, managers seem to be significantly affected by the challenge of carrying out the task assigned to them in the time available. As noted by Hugo, “…no one, or almost no one, can get everything done; no one is able to say, ‘I completed everything.’ There is always a pile [of jobs] that awaits you and you always work on what is the most urgent.”

Support for staff has to fit in with all the tasks that need to be accomplished and can therefore be influenced by the need to prioritize that confronts middle managers. Some managers are clear about their wish to prioritize support for their staff: “I swore that in my work I will never leave a staff member with a broken basket. This [priority] fits with my nature and I try my hardest to not ignore things and to deal with things quickly for my staff.” (Léa). Despite this clearly expressed wish, some managers highlighted the difficulty they experienced, given their workload, in prioritizing their support and being as available as they would like to be to their staff: “I try to be more available for staff, but, very often, my day is planned. If things are added, things are dealt with between two meetings, during lunch time or after 4.30 PM.” (Anne).

Table 5

Individual factors that facilitate or constrain middle manager support

Individual factors that facilitate or constrain middle manager support

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The time spent doing all the other tasks is therefore time that managers cannot spend on staff support. Managers have trouble making choices among various priorities: “I need to clear emotional space to do it. When I’m here this morning and in the afternoon I have my team meeting, how do I do it, among all the things that I have to do, how do I make the space to give quality time to that individual?” (Hugo). This pressure therefore has an impact on the use of the support strategies that have been identified. Thus, although managers identified listening carefully, for example, as a particularly important support strategy, the significant work constraints can hinder the use of this strategy on a daily basis. “…you can’t take two hours of your meeting to vent because there are many other points to discuss; you lose too much time discussing other things.” (Marc).

As well as having to prioritize time to carry out their heavy workload, middle managers also have to position themselves sometimes between the demands of the organization and the needs of their staff, a position that can also lead to difficult choices regarding actions. As noted by Chloé:

It’s me who has to cope with it and…where I see another pressure, it’s when the staff aren’t doing well because things are difficult, because there are difficult situations. When a staff member is struggling and crying, I have to go and see my manager and he talks about statistics and everything, “you have to keep things moving because the statistics aren’t good.” Thus, I have to find a way to make him hear that it’s not the staff member’s fault, that when they’re not doing well, we have to find strategies to help things get better. I find that difficult.

Despite the diverse support strategies we identified, some managers said that because of the constraints they have to work with they could feel limited in their actions and experience a certain feeling of powerlessness: “When I sense that staff are exhausted, that their workload is very high and there are emergencies that arrive more and more frequently or that I’m unable to give them a break because I don’t have enough staff […] I feel limited.” (Diane).


Links with Previous Findings

Our findings have revealed a range of strategies used by middle managers to support staff who work in a context where work is recognized as emotionally demanding. Some of the strategies have previously been identified in the literature, albeit not in this specific context. Emotional support, for example, and in particular the main strategy of listening, has been noted in some other investigations (Ericson-Lidman and Strandmerg, 2009; Kramer et al., 2007; Lewis et al., 2012; Ruiller, 2011; Sherman et al., 2007). Providing clinical support also has been identified previously, as has facilitating cohesion within the team (Kramer et al., 2007). Conflict management is a recurring element in some investigations (Kramer et al., 2007; Lewis et al., 2012; Sherman et al., 2007). Regarding the strategies to adjust the workload of the staff and the steps to improve the conditions in which they carry out their work, the findings of some other investigations have highlighted the desire of managers to be open and flexible in the development of work plans and schedules (Ruiller, 2011; Sherman et al., 2007; Skagert et al., 2008). With respect to recognizing staff’s work, our results echo those of some other studies (Côté and Denis, 2018; Fall, 2014; Li et al., 2011; Ruiller, 2011; Sherman et al., 2007). With respect to adopting attitudes deemed to be supportive, there is also a mention of attitudes of this kind in Lewis and colleagues’ (2012) investigation in which managing emotions, remaining calm, adopting a relaxed attitude and using humour are among the skills that enable managers to prevent and reduce stress in the staff they supervise. Sherman et al. (2007) identified the importance of self-control and being a role model in managing stress. Finally, the importance of being present and available was also noted in some other investigations (Kramer et al., 2007; Sherman et al., 2007).

New Insights

In addition to strengthening some previous findings, our results provide a comprehensive portrait of the actions, including their diversity, carried out by middle managers to support staff with emotionally demanding work. Furthermore, mapping the support strategies on proximity and time axes has provided some important insights. Support can be provided directly to staff, but it can also include some actions about which the staff may not even be aware. These findings seem consistent with the notion that middle managers have to develop both upward (directed toward senior managers) and downward (directed toward staff) strategies in their efforts to support their staff (Côté and Denis, 2018). Some other authors have also noted certain strategies that can be considered indirect, for example, staff protection strategies and representations (Desmarais and Abord de Chatillon, 2010; Kramer et al., 2007; Skagert et al., 2008). As well, one may consider indirect some of the strategies identified by Côté and Denis (2018) and used by middle managers during periods of health care reform, for example, the creation of a network of alliances and the negotiation of values.

Our findings also revealed that short-term strategies, in the face of immediate demands, tend to be used more often than strategies for broader, long-term changes. This trend might be associated with the constraints experienced by managers who, when confronted by time constraints, prioritize responses to the most immediate needs. This tendency may also be associated with the fact that managers often have to deal with emergencies. These findings are consistent with Mintzberg’s (2007) reflections on the rapid pace, variety, brevity and discontinuity of managers’ activities, which are more oriented to immediate action.

However, the need to respond to immediate situations may not fully explain why so few strategies are aimed at longer-term improvement, for example, making representations to senior managers about improving the staff’s work conditions. Some of the latter strategies aim to reduce the sources of stress by focusing on the organization and work environment and can be viewed therefore as playing a role in the prevention of work-related psychological health issues. Our findings are interesting in light of the research evidence on the greater effectiveness of such strategies versus the effectiveness of those that are focused on the more immediate individual level (Brun et al., 2003). A combination of factors may explain our findings, including the possibility that managers may be experiencing feelings of helplessness, as well as a certain habituation to the constrained context, which could lead to some reluctance to endeavour to change the situation. As well, middle managers have to find a way of juggling their accountability to senior managers with their representation of staff.

The utility of an ergonomic perspective is highlighted by our findings on the facilitating or constraining organizational, interpersonal and individual factors that might influence adoption of the various strategies used by middle man-agers. These findings bear some similarities to those of Skagert et al. (2008), who likewise highlighted the important role of contextual factors in the actions that managers can take to help reduce the stress experienced by their staff as well as their own stress. The influence of certain constraints on the way managers can support staff also is consistent with the observation of Bolduc and Baril-Gingras (2010) that the conditions under which many managers work do not allow them to fully perform the role that they wish to play with staff. The same authors also reported the main constraint mentioned by the managers they had interviewed: the time constraints that limit, among other things, their presence with the teams they oversee. The impact on time constraints also has been noted in some other studies (Detchessahar, 2011; Habery-Knuessi, Heeb and de Morgan, 2013). For example, Detchessahar noted that managers must devote themselves to other time-consuming tasks, such as administrative tasks, including those related to various management indicators, or various meetings and committees. The notions of Smith and Lewis (2011) on the paradoxical nature of organizations seem relevant here; in the context that we have described, the innately emotionally demanding nature of the work, which requires greater support from middle managers, is in tension with a diminishing availability of their time to provide such support.

Our research also revealed certain factors that make it easier to offer support to staff. This information helps to provide a broader picture of the elements that affect the actual work activity of middle managers and the strategies they use to support staff. For example, the presence of moments of exchange already planned during statutory meetings—when such moments are not restricted by time—can facilitate the use of listening, the sharing of a common vision, and the development of solidarity on a team faced with difficulties. The availability of certain resources, such as an employee assistance program, adds to the potential for strategies that managers can use. Kramer et al. (2007) also noted some organizational structures and practices that favour supportive behaviours among middle managers, for example, support to senior managers, as well as to fellow managers, availability of professional development, and strong organizational culture with shared values. Bolduc and Baril-Gingras (2010) noted some specific resources available to managers to facilitate their role (e.g., advice from human resources personnel). Such resources augment the agency (Emirbayer and Mische, 1998) of managers in their endeavours to better support their teams and more effectively advocate for their interests with senior managers.

It is difficult to gauge the extent to which the middle managers in our investigation feel isolated in their role; such perceptions appear to be influenced by several variables, for example, concern about burdening already busy colleagues or not appearing capable of managing their own tasks. Some literature suggests that although the nature of middle managers’ work means that they are often in competition with each other, they also show solidarity in difficult situations (Côté, Bourdages-Sylvain and Denis, 2020). This spirit of solidarity was demonstrated by our participants. In the Quebec context of our study, middle managers in the health and social services sector can belong to the Association des gestionnaires des établissements de santé et de services sociaux (Association of Managers of Health and Social Service Institutions). Among other roles, the association informs, advises and represents its members, as required, in order to ensure that their rights are respected.

Among individual factors that facilitate or constrain the managers’ support for their staff, there is probably, up to a certain point, some variability among individuals in their personal styles, for example, their level of empathy. Of greater interest are the findings that appear more related to the managers’ individual responses to the context in which they are trying to perform their roles, for example, their habituation to the context and the situation, their feeling of powerlessness, the difficulties they are experiencing with their own psychological or physical health or the difficulty in seeking support. It seems paradoxical that managers themselves do not necessarily seek or have access to the type of support that they advocate for their staff. These various elements suggest that managers should be suitably supported and equipped before they can support their teams.

The necessary prioritization that managers are obliged to exercise in contexts where they are confronted by various constraints appears to be an important element that needs to be taken into account because of the impact that it may have on the support strategies that they adopt. From an ergonomic perspective, this finding is consistent with Darses and Montmollin’s (2012) observation that prioritization is naturally at the heart of the managers’ work activity. In the context of the constraints within which they frequently have to function, managers can find themselves having to make choices that are not without influence on the support they can offer to staff. In fact, in our findings, the label given to most of the strategies identified could have started with “taking the time to ...”.

Avenues for Future Research

Several avenues for further research emerge from our findings. First, investigation is needed into the impact of certain factors on the choice of support strategies, e.g., the tendency of several managers to want to be in control, to be reluctant to ask for help or to share their difficulties. Second, relatively little is known about how managers prioritize their activities, except that they must do so in a setting where activities follow one another quickly and are often interrupted. Although professional development was mentioned as being important and had been integrated into strategies to help managers provide staff with better support, few managers actually made reference to their own professional develop- ment experiences, tending to privilege the usefulness of their experience. In a related vein, there clearly seems to be a need for further research on how middle managers themselves experience emotionally demanding work in the context of their role. Based on the links identified between some of our study’s findings and the existing research, it is possible that the range of strategies used by middle managers, and the factors influencing those strategies, are not exclusive to contexts in which the work is considered emotionally demanding. It would be useful to have a clearer idea of the extent to which this broader applicability might be the case. Finally, although our research revealed the strategies used by middle managers to support staff, a relevant next step would be to study the impact of those strategies and to integrate the perceptions of staff and their needs into our understanding of the subject.

Limitations of the Study

The fact that we did not directly observe the work of middle managers is a limitation on our research because direct observation is one of the preferred data collection methods for ergonomic analysis of work activities. Nonetheless, the legitimacy of using other data collection strategies has been recognized (Darses and Montmollin, 2012). Thus, although there was no direct observation of the work activity, and although the managers might have omitted some details from their descriptions, the interview transcripts show a range of strategies used by these individuals, thus providing a portrait that seems representative of their reality. As well, the validation of the results with the advisory committee and the close involvement of the researchers in the research setting over several years (for the broader study) provides extra support for their accuracy. Another potential limitation is the possibility of self-selection bias among the managers who chose to participate. As a form of data collection, focus group interviews, despite their advantages, can also be a source of bias, for example due to the possible ripple effect or self-censorship of certain ideas for fear of judgment. Although we cannot rule out such a possible effect, the richness of the results that emerged suggests that this data collection approach was appropriate. There may be a limitation in the fact that the interviews were part of a broader research project, and thus without a specific focus on the research question addressed in this article; moreover, the findings emerged from secondary analysis of the interviews. However, we were able to answer our research question, thanks to the wealth of collected data and to the concern, already present within the framework of the research, for the strategies used by the managers to meet challenges.


Our study reveals that middle managers use a range of support strategies to help their staff cope with emotionally demanding work. The seven categories of strategy we identified are distributed along two axes, proximity (direct, indirect) and time (short-term, long-term). The strategies tend to be more direct and short-term. The managers’ choice of strategy is influenced by various facilitating or constraining organizational, interpersonal and individual factors. However, time pressures appear to be the one that plays the most important role in influencing the strategies adopted. Our findings suggest several avenues for further research, for example, investigating the impact of these strategies on staff and exploring how middle managers themselves experience emotionally demanding work in the context of their role.