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International Journal of Nursing Practice 2014; ••: ••–••

RESEARCH PAPER

The relationship between characteristics of nursing performance and years of experience in nurses with high emotional intelligence Yuriko Fujino RN PhD Associate Professor, Fukuoka Jogakuin Nursing College, Fukuoka, Japan

Michiko Tanaka RN PhD Assistant Professor, R&D Laboratory for Innovative Biotherapeutics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan

Yoshikazu Yonemitsu MD PhD FAHA Professor, R&D Laboratory for Innovative Biotherapeutics, Graduate School of Pharmaceutical Sciences, Kyushu University, Fukuoka, Japan

Rieko Kawamoto RN MA PhD Executive Officer, Japanese Nursing Association, Tokyo, Japan

Accepted for publication August 2013 Fujino Y, Tanaka M, Yonemitsu Y, Kawamoto R. International Journal of Nursing Practice 2014; ••: ••–•• The relationship between characteristics of nursing performance and years of experience in nurses with high emotional intelligence The aim of this study was to elucidate characteristics of nursing performance among nurses with high emotional intelligence (EI) and examine the influence of years of experience on nursing performance and EI. A survey, including The Emotional Intelligence Scale and the Six-Dimension Scale of Nursing Performance, was administered to 1395 nurses working at general hospitals in Japan from November 2010 to March 2011. We received 1045 responses (76% response rate). There was a significant positive correlation between EI and nursing performance. Nurses with high EI reported more professional development activities, suggesting that they continue learning, attain licenses and actively improve their nursing skills. High-performing nurses had high situational abilities and showed improved nursing performance with experience. However, nurses with low situational abilities demonstrated no improvement in nursing performance related to experience. EI involves skills that can be acquired from training. Therefore, educational programmes to improve EI could improve nursing performance. Key words: Emotional Intelligence Scale (EQS), emotional intelligence, nursing performance, Six-Dimension Scale of Nursing Performance (6DS).

Correspondence: Yuriko Fujino, R&D Laboratory for Innovative Biotherapeutics, Graduate School of Pharmaceutical Sciences, Kyushu University, Room 601, Station II for Collaborative Research, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan. Email: fyuriko@ med.kyushu-u.ac.jp doi:10.1111/ijn.12311

INTRODUCTION Nursing is a profession based on interpersonal relationships and is regarded as emotional labour because it involves assessing and controlling the emotions of oneself © 2014 Wiley Publishing Asia Pty Ltd

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and others1; therefore, improvement of emotional intelligence (EI), which is the ability to deal effectively with interpersonal relationships and emotions, is essential for nurses. Goleman proposed the concept of EI2 that is involved in coping with stress and with demands and pressures brought about by environmental changes in the workplace, such as organizational changes.3 In leadership, not only technical skills but also skills in responding to co-workers, bosses and subordinates based on EI are important as well.2 In the West, EI has been applied in circumstances of employment, placement, promotion, training and stress management in actual personnel administration.4 Previous studies examining EI in the nursing field have suggested that nursing managers who have high EI significantly contribute to nursing care, staff and the organization as a whole,5,6 and are effective in preventing burnout and facilitating stress management.7,8 Thus, EI is necessary to keep nurses physically and mentally healthy. Moreover, there have been increasing numbers of studies focused on educating and training EI ability as EI is related to leadership and decision-making5,6,9 which strongly affect patient care.10,11 What are the characteristics of nursing performance among nurses who have high EI? EI plays an important role in nurses’ ability to develop trusting relationships with patients.7 It would be anticipated that nurses with high EI demonstrate high nursing performance. However, few studies have compared nursing performance using an objective index. Codier et al.12 examined the relationship of EI and level of nursing performance, as indicated by position on the clinical ladder. They revealed that nurses who had high EI had high nursing performance and career longevity. However, specific characteristics of nursing performance related to EI have not been clearly identified. Using the Six-Dimension Scale of Nursing Performance (6DS),13 an instrument in use since 1978 as an index of nursing performance, Beauvais et al.10 analysed the relationship of scores on the six dimensions with EI. However, their sample comprised only nursing students.10 What are the characteristics of EI among highperforming nurses? Kooker et al.14 performed qualitative research regarding domains and competencies related to EI among certified nurses. They showed that the most effective EI domain was social awareness, and that those who had high nursing performance effectively managed social situations in their nursing practice. The Emotional © 2014 Wiley Publishing Asia Pty Ltd

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Intelligence Scale (EQS) measures EI and includes a situational domain.15 Research using the EQS has shown the importance of the situational domain for nurses. Situational judgment is necessary for nurses’ mental health16 and can be improved by self-awareness training for newly graduated nurses.17 Nurses working in a fast-changing modern society must be able to make situational judgments in interpersonal relationships, yet few studies have examined the relationship between nursing performance and situational aspects of EI. Furthermore, do years of experience affect the relationship between nursing performance and EI? Although there is research revealing a negative correlation between age and emotional empathy,11 there is a dearth of research examining EI and experience. EI might be acquired through education and training.2,18 Thus, if experience does not improve EI, we should evaluate current teaching methods. Therefore, the aim of this study was to elucidate the characteristics of nursing performance among nurses who have high EI and the influence of years of experience on the relationship between EI and nursing performance. Our findings have implications for effective educational methods aimed at developing EI and thus improving nursing performance.

METHODS Participants Participants were 1395 nurses working at general hospitals. We asked directors of nursing departments to cooperate in the study and included those hospitals that agreed to participate. The researchers explained the aim and ethical considerations of the questionnaire to the directors or head nurses and asked them to distribute it. Upon completion, questionnaire forms were sealed by respondents and collected in each department within 2 weeks. The questionnaire was administered from November 2010 to March 2011.

Data collection The self-report questionnaire collected information on age, sex, years of experience, position (management, staff) and educational background (graduate school, university, 2 year college, technical school) as individual attributes. Emotional intelligence was measured using the 65-item EQS developed by Uchiyama et al.15 The reliability and validity of this instrument have been established. The scale

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Figure 1. Conceptual and operational structure of the Emotional Intelligence Scale.

comprises three factors in each of three domains: intrapersonal (self-awareness, self-motivation, selfcontrol), interpersonal (empathy, altruism, interpersonal relationships) and situational (situational awareness, leadership, flexibility) (Fig. 1). The response choice for each item is recorded on a 5-point Likert scale, with larger numbers indicating a higher level of emotional intelligence. The total score for the scale is 0 to 252. Cronbach’s alpha for this study was 0.91. Nursing performance was measured using the 6DS developed by Schwirian.13 This scale divides nursing performance into 52 items in six domains (leadership, critical care, teaching and collaboration, planning and evaluation, interpersonal relationships and communication, and professional development). After obtaining permission from the developer of the scale, the researchers and others translated and retranslated the 6DS for use in this study. The scale was first translated by a nurse who had more than 10 years’ experience in the English-speaking world and a non-medical professional with a specialty in English literature. To confirm the validity of the content, the scale was examined at meetings of five nursing researchers who had a master’s degree or higher education and more than 5 years of clinical experience. Furthermore, to ensure equivalence with the original, back translation was implemented by a bilingual undergraduate student and a nurse who had more than 2 years’ experience studying abroad, and who had not seen the original 6DS. When the scale was used in the survey, the Cronbach’s coefficient alpha was 0.92 for the whole scale and 0.90–0.91 for each subscale.

Ethical considerations We explained in writing the following information, and regarded answering the questionnaire as an indication of participants’ consent. The survey was conducted on an

anonymous basis, and the data were processed using code numbers so that individuals could not be identified. Answering the questions was voluntary, with no disadvantage resulting from not answering them. The study was conducted after obtaining approval of the Kyushu University Hospital Ethics Committee in October 2010.

Data analysis Statistical software JMP version 9 was used for data analyses (SAS Institute Inc., Cary, NC, USA). We calculated demographic data for each individual attribute, EQS and nursing performance. Then Pearson’s product-moment correlation coefficients were calculated to ascertain the relation between EI and nursing performance. Moreover, a two-way analysis of variance was performed to examine the influence of years of experience on the relationship between nursing performance and EI. This was done by dividing the most effective scores of EI into high and low groups and years of experience into four categories.

RESULTS Characteristics of the participants We distributed the questionnaire to 1395 nurses and received responses from 1060. Of those, 1045 questionnaires without missing data were analysed in the study (collection rate 76.0%; valid response rate 96.2%). Characteristics of the participants are shown in Table 1. The average age was 32.1 ± 9.0 years (range 20–60 years), and 986 were women (94.4%). By position, there were 115 managers (11.0%) and 930 staff (89%). years of experience ranged from 1 to 41 years, with an average of 9.9 years (SD ± 9.1). The breakdown by highest academic degree was as follows: 412 technical school graduates (39.6%), 220 two-year college graduates (21.2%), 391 university graduates (37.6%) and 11 graduate school graduates (1.1%). © 2014 Wiley Publishing Asia Pty Ltd

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Table 1 Characteristics of the participants (n = 1045) Characteristic Age (years)

Gender Position Nursing experience (years)

Degree

20–29 30–39 40–49 50–60 Male Female Manager Nursing staff 1–5 6–10 11–20 21–41 Diploma Associate BS MS

n

%

557 287 124 73 59 986 115 930 412 177 164 126 412 220 391 11

53.5 27.6 11.9 7.0 5.6 94.4 11.0 89.0 46.9 20.0 18.7 14.3 39.6 21.2 37.6 1.1

EQS We evaluated EI using the Japanese version of the EQS. The EQS average total score of participants was 113.3 (SD ± 31.3), with a range of 27–218. Scores for the subscales were as follows: intrapersonal domain 37.5 (SD ± 10.6, range 7–73), interpersonal domain 41.1 (SD ± 11.8, range 6–78) and situational domain 34.8 (SD ± 34.8, range 3–78). Results showed that among participants in this study, scores for the interpersonal domain were the highest.

Nursing performance The mean score on the 6DS, which is the subject’s total score divided by the number of items, was 2.82 (SD ± 18.9). Scores for subscales of the 6DS were the following: leadership (M = 2.74, SD ± 2.42), critical care (M = 2.74, SD ± 3.47), teaching and collaboration (M = 2.74, SD ± 3.47), planning and evaluation (M = 2.90, SD ± 2.78), interpersonal relationships and communication (M = 3.97, SD ± 4.23), and professional development (M = 2.78, SD ± 4.29).

Relation between EQS and nursing performance We investigated Pearson’s correlation coefficients to examine the relation between total EQS score and total 6DS score (Table 2). Results indicated a modestly strong © 2014 Wiley Publishing Asia Pty Ltd

positive correlation (r = 0.45, P < 0.001) between the two scales. That is, those who had high EI also had high nursing performance. The relations between total EQS score and scores on subscales of the 6DS were significantly different among the subscales. The strongest positive correlation was between EQS and the professional development subscale (r = 0.44). Regarding the relation between total 6DS score and subscales of the EQS, the strongest positive correlation was between total 6DS score and the situational domain (r = 0.49). Both the interpersonal and situational domains of the EQS were strongly related to nursing performance. With regard to factors in the intrapersonal domain, self-awareness (r = 0.40) showed a modestly strong positive correlation with total 6DS score. A two-way analysis of variance was performed to examine the influence of years of experience on the relationship between nursing performance and EI, using the situational domain, which was the most effective type of EI. The results showed significant differences in the two levels of situational abilities (F = 98.5, P < 0.001) and four categories of years of experience (F = 23.2, P < 0.001). The group with high situational abilities showed high nursing performance, with their performance improving with years of experience. The group with low situational abilities, in contrast, demonstrated no improvement in their nursing performance related to years of experience (Fig. 2). There was no interaction between EI and years of experience in terms of nursing performance.

DISCUSSION Relation between emotional intelligence and nursing performance A significant positive correlation was found between EI and nursing performance. That is, nurses with high EI had high nursing performance, consistent with results of Codier et al.12 and Beauvais et al.10 Regarding the relation of total 6DS score with EQS subscales, nursing performance was most strongly associated with the situational domain. It was anticipated that nursing performance would be strongly related to the interpersonal domain because nursing is based on interpersonal relationships and involves high empathy and altruism. However, the relation of nursing performance with the situational domain of EI, with EQS subscales including situational awareness, leadership and flexibility,

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Table 2 Correlations between emotional intelligence (EQS) and nursing performance (6DS) (n = 1045) Emotional intelligence

Nursing performance

Total score Leadership Critical care Teaching and collaboration Planning/evaluation Interpersonal relations and communication Professional development

Total score

Intrapersonal

Interpersonal

Situational

0.45*** 0.39*** 0.39*** 0.38*** 0.32*** 0.40*** 0.44***

0.42*** 0.36*** 0.37*** 0.33*** 0.31*** 0.38*** 0.42***

0.28*** 0.23*** 0.22*** 0.24*** 0.20*** 0.34*** 0.27***

0.49*** 0.43*** 0.43*** 0.41*** 0.35*** 0.39*** 0.47***

*** P < 0.001. EQS, Emotional Intelligence Scale; 6DS. Six-Dimension Scale of Nursing Performance.

group including oneself and others, and fosters leadership ability. In other words, the practice of nursing requires the ability to not merely build relationships easily, but also to judge the situations of patients and families, respond with quick wit in various situations (e.g. risk management and group guidance) and control those situations. We posit that the relation of nursing performance with the ability to address such diverse situations was strongest for these reasons.

Influence of years of experience

Figure 2. Mean score for situational abilities related to nursing ) high skill, performance by years of experience (n = 1045). ( ) low skill. (

was the most significant. Akerjordet and Severinsson19 suggested that nurses’ EI is a creative process based on senses and instincts that allow nurses to immediately grasp and interpret situations and make decisions. Nurses must judge emotions arising in themselves and others in interpersonal interactions and take appropriate actions at that moment. This might explain the stronger association between nursing performance and situational abilities. Skill in the situational domain represents the ability to endure changes in circumstances surrounding oneself or a

A two-way analysis of variance was performed to examine the influence of years of experience on the relationship between situational abilities and nursing performance. Situational abilities, which are one of the domains of EI, reflect judgment and adaptability depending on the circumstances. These abilities are important in practical nursing areas. This might explain why those with low situational abilities demonstrated continued difficulties in their nursing performance despite increasing years of experience. EI is said to be the essence of nursing4 and can be acquired from training.2,18 Therefore, introducing education in nursing programmes to improve EI should improve nursing performance.

Characteristics of nurses with high EI The average total score of EQS confirmed that our sample was representative in terms of EI ability, and was similar to results obtained by Uchiyama et al.15 Regarding total EQS score and the subscales of the 6DS, the highest positive correlation was found between EQS score and professional development. Thus, there is a relationship © 2014 Wiley Publishing Asia Pty Ltd

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between high EI and professional development. In a study by Beauvais et al.,10 EI was most strongly correlated with professional development, compared with the other subscales of the 6DS. EI is reportedly related to professional attitudes and experiences in the development of nursing knowledge.19,20 Professional development involves improving one’s own specialty through the acquisition of degrees or other qualifications. To improve their abilities, nurses must participate in training, acquire new competencies, and engage in continuous learning and widely varied activities. In that way, EI can be improved. Our findings suggest that EI ability is important in improving professional competence in nursing practice.

Conclusion Nurses with high EI tend to engage in professional development activities. Improved EI in nurses might result from a desire to develop professionally and a sensitivity for gathering information from surroundings. In addition, nurses with a high level of nursing performance have high situational abilities. They are required to perform appropriately by quickly judging their own and others’ emotions in interpersonal contexts. The EI ability to judge situations can contribute to high nursing performance. Analysis of the influence of years of experience revealed that nurses with high ability in the situational domain showed improved nursing performance with more years of experience, whereas nurses with low situational abilities demonstrated no improvement in their nursing performance with more years of experience. These findings indicate the necessity of educational programmes on EI, centred on the situational domain, as EI is an ability that can be improved by training. The development of educational programmes related to EI can facilitate improved performance among nurses and contribute to their career longevity.

ACKNOWLEDGEMENTS We would like to express our thanks for the contribution and dedication of all the nurses who participated. This research was supported by a Grant-in Aid for Scientific Research (C) 21592696 of the Ministry of Education, Culture, Sports, Science and Technology, Tokyo, Japan.

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2 Goleman D. Emotional Intelligence. New York: Bantam Books, 1995. 3 Bar-On R. The impact of emotional intelligence on subjective well-being. Perspective in Education 2005; 23: 22. 4 Matthews G, Zeidner M, Robers R. Emotional Intelligence: Science and Myth. Cambridge, MA, USA: MIT Press, 2004. 5 Muller-Smith P. Yet another workplace crisis. Journal of Perianesthesia Nursing 1999; 14: 217–220. 6 Snow JL. Looking beyond nursing for clues to effective leadership. Journal of Nursing Administration 2001; 31: 440– 443. 7 McQueen A. Emotional intelligence in nursing work. Journal of Advanced Nursing 2004; 47: 101–108. 8 Moyer BA, Wittmann-Price R. Nursing Education: Foundations for Practice Excellence. Philadelphia: F.A. Davis, 2008 (R2 Library, online service). 9 Chabeli M. Higher order thinking skills competencies required by outcomes-based education from leaders. Curationis 2006; 29: 78–86. 10 Beauvais AM, Brady N, O’Shea ER, Griffin MT. Emotional intelligence and nursing performance among nursing students. Nurse Education Today 2011; 31: 396–401. 11 Harper MG, Jones-Schenk J. The emotional intelligence profile of successful staff nurses. The Journal of Continuing Education in Nursing 2012; 43: 354–362. 12 Codier E, Kooker BM, Shoultz J. Measuring the emotional intelligence of clinical staff nurses: An approach for improving the clinical care environment. Nursing Administration Quarterly 2008; 32: 8–14. 13 Schwirian PM. Evaluating the performance of nurses: A multidimensional approach. Nursing Research 1978; 27: 347–351. 14 Kooker BM, Shoultz J, Codier EE. Identifying emotional intelligence in professional nursing practice. Journal of Professional Nursing 2007; 23: 30–36. 15 Uchiyama K, Torii T, Urugi S, Ootake K. EQS Manyuaru [Manual]. Tokyo: Business Education, 2001. 16 Kitahara N, Bohgaki T, Yamamoto H. Relationships of the subjective well-being and emotional intelligence for nurses. International Nursing Care Research 2011; 10: 11–19. 17 Kusaka K. Effectiveness of a programmed lecture on selfunderstanding of emotion and autonomy in novice nurses. The Kitakanto Medical Journal 2010; 60: 353–361. 18 Mayer JD, Salovey P. Emotional intelligence and the construction and regulation of feelings. Applied and Preventive Psychology 1995; 4: 197–208. 19 Akerjordet K, Severinsson E. Emotional intelligence in mental health nurses talking about practice. International Journal of Mental Health Nursing 2004; 13: 164–170. 20 Jordan PJ, Troth AC. Emotional intelligence and conflict resolution in nursing. Contemporary Nurse: A Journal for the Australian Nursing Profession 2002; 13: 94–100.

The relationship between characteristics of nursing performance and years of experience in nurses with high emotional intelligence.

The aim of this study was to elucidate characteristics of nursing performance among nurses with high emotional intelligence (EI) and examine the influ...
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