In the past decade, nursing leaders have taken an increased interest in the concept of emotional intelligence (EI) and have deemed it to be a key factor for the development of effective, caring nurse leaders. It has been suggested that EI should be at the heart of the nursing curriculum as an integral part of nursing students’ education (Bellack et al., 2001; Evans & Allen, 2002; Freshwater & Stickley, 2004; McQueen, 2004; Snow, 2001). However, there has been relatively little research on the concept of EI in nursing and even less on EI and undergraduate nursing students. It is not known if or how EI changes over the course of a nursing educational program or how these changes are associated with changes in leadership and caring abilities.
Although there are a number of different models and definitions of EI (Goleman, 1998; Mayer & Salovey, 1997), in this article we use the commonly used definition by Bar-On (2002). He refers to emotional–social intelligence (ESI), which is defined as “a multi-factorial array of emotional and social competencies that determine how effectively we relate with ourselves and others and cope with daily demands and pressures” (Bar-On, 2002, p. 31).
Emotional intelligence encompasses both intrapersonal and interpersonal skills (Bar-On, Maree, & Elias, 2007). Individuals with high intrapersonal EI have a heightened self-awareness of their emotions, feelings, and attitudes; are aware how these may affect their interactions with others; and can manage them in a positive and productive manner. Interpersonal EI relates to the ability to understand others, to establish rapport, and to work effectively, cooperatively, and collaboratively with others. These personal and social competencies also entail being comfortable with, caring about, and paying attention to the reactions and responses of others, as well as sharing knowledge to develop, empower, and motivate others (Goleman, 1998; Vitello-Cicciu, 2002, 2003). The aforementioned are competencies that nurses traditionally value as components of effective leadership and professional caring behaviors (Akerjordet & Severinsson, 2008; Cummings, Hayduk, & Estabrooks, 2005; Kooker, Shoultz, & Codier, 2007; McQueen, 2004).
Emotional intelligence has been measured in nursing students, but only in cross-sectional studies. Benson, Ploeg, and Brown (2010) used the BarOn Emotional Quotient Inventory: Short version (EQ-i:S™) and reported mean scores in the effective range for students in years 1 to 4, with significant differences only between first-year and fourth-year students. On the other hand, Duygulu, Hicdurmaz, and Akyar (2011) found no difference between first-year and final-year nursing students when using the long version of the EQ-i.
Emotional intelligence is considered a critical aspect of effective nursing leadership (Herbert & Edgar, 2004). It has been suggested that EI involves many of the characteristics and outcomes attributed to effective nursing leadership, such as open communication, negotiation, relationship building, optimism, working with people to enhance accomplishments, and creating and sustaining inclusive environments (Herbert & Edgar, 2004). Stichler (2006) maintained that effective, emotionally intelligent nurse leaders empower nurses, prevent job stress, and contribute to job satisfaction and retention. Indeed, nurses have reported that their own feelings of empowerment and organizational commitment have been enhanced by the emotionally intelligent behavior of their supervisors (Lucas, Spence Laschinger, & Wong, 2008; Young-Ritchie, Spence Laschinger, & Wong, 2009).
Cummings et al. (2005) studied the effects of hospital restructuring on nurses and the extent to which the type of leadership mitigated the detrimental consequences of restructuring. They found that nurses working for resonant leaders (high EI–empathic and supportive) reported significantly better emotional health, less emotional exhaustion, fewer psychosomatic symptoms, greater workgroup collaboration and teamwork with physicians, and more satisfaction with supervision and their jobs than nurses working for dissonant leaders (low EI). Through preparing nurses to develop EI competencies and the leadership abilities that EI fosters, there is a potential to reduce burnout and improve nursing retention and patient outcomes (Birks, McKendree, & Watt, 2009; Kooker et al., 2007; McQueen, 2004; Young-Ritchie et al., 2009).
The relationship between EI and leadership in nursing students is less clear. Beauvais, Brady, O’Shea, and Quinn Griffin (2011) studied 87 nursing students in a university setting and found that total EI was significantly related to total nursing performance (i.e., teaching and collaboration, planning and evaluation, interpersonal relations and communication, and professional development components) but not to leadership and critical care. Duygulu et al. (2011) reported a significant correlation (r = 0.43) between EI and task-oriented leadership but not between EI and people-oriented leadership among Turkish nursing students.
Caring is another key concept integral to professional nursing (Duffy, 2005; Mayeroff, 1971)—a quality valued by recipients of nursing care (Griffiths, Speed, Horne, & Keeley, 2011) and one that has been linked to EI (Cadman & Brewer, 2001; McQueen, 2004; Rego, Godinho, McQueen, & Cunha, 2010; Wessel et al., 2008). Caring, according to Mayeroff (1971), is helping the other to grow, with major dimensions of knowing, patience, honesty, trust, humility, hope, courage, and alternating rhythms. In her review, Duffy (2005) referred to caring as “the core or essence of nursing and the basis for nursing interventions” (p. 62).
Emotional intelligence competencies encompass many of the components essential in human and professional caring. Wagner (2006) stated that:
implicitly threaded throughout definitions of caring is the need to develop a sense of self, a sense of knowing one’s beliefs and values, intention to help, moral commitment to be present, ability to respond competently to another’s need, and willingness to enter into therapeutic relationships that encourage human connectedness.
We do not know how EI changes over the course of a nursing educational program and whether these changes are related to changes in leadership and caring. If EI is a prerequisite for effective, competent professional nursing practice, the deliberate development of such skills among students in educational programs may produce caring nurse leaders who are more likely to be successful in the current rapidly changing and often stressful health care environment. The purpose of this longitudinal study was to assess the changes in and relationships between EI and measures of leadership and caring among nursing students from the start to the end of their educational program.
The research questions were:
- What are the changes in EI, leadership, and caring in undergraduate student nurses from Time 1 (T1, entry into the program) to Time 2 (T2, following early clinical performance) to Time 3 (T3, exit from the program)?
- What is the relationship between changes in EI and changes in leadership and caring in undergraduate student nurses from the beginning to the end of their program?
A correlational, repeated measures design was used in this study. A cohort of Bachelor of Science in Nursing students completed self-report questionnaires on EI, leadership, and caring at entry to their program (T1, fall 2006), after their second year and first clinical experience with patients (T2, spring 2008), and at the end of their 4 years of study (T3, spring 2010). The time to complete all tools was approximately 45 minutes.
Setting and Participant Recruitment
The setting for the study was a 4-year collaborative Bachelor of Science in Nursing program that is offered at three sites (one university and two colleges). This program is founded on a self-directed and problem-based approach and has at its core an andragogical educational philosophy. In year 1, students are provided with a strong basis in the health and social sciences. Learning occurs in the classroom and laboratory settings where the students learn about themselves and their clients as individuals. In years 2 and 3, students begin to consider the family and the community as clients and spend time in varied clinical settings caring for patients. In year 4, students consider health care from a more global perspective and begin to focus on issues such as leadership and health systems.
All students enrolled in their first year of the program were informed via e-mail of the study purpose, method, expectations of participants, potential risks and benefits, and their ability to withdraw at any time without consequence. Students interested in participating in the study were invited to attend an information session or to contact the principal investigator by e-mail. Participating students were given a $5 coffee shop gift certificate following completion of each data collection session.
Seventy-six nursing students, from a possible pool of 385 students admitted to the nursing program, volunteered to participate; only 52 students completed the questionnaires at all three time intervals. Ethical approval was obtained from the university’s research ethics board. All participants provided written informed consent.
Participants completed the following tools at each data collection period: (a) EQ-i:S (Bar-On, 2005), (b) the Self-Assessment Leadership Instrument (SALI) (Smola, 1988), (c) the Caring Ability Inventory (CAI) (Nkongho, 2003), and (d) the Caring Dimensions Inventory (CDI) (Watson & Lea, 1997).
The EQ-i:S is a measure of emotional and social intelligent behaviors (Bar-On, 2002, 2004) and contains 51 items in the form of short sentences. Respondents rate each statement from 1 (very seldom or not true of me) to 5 (very often or true of me). The EQ-i:S generates a total EQ score and five subscale scores: (a) intrapersonal (i.e., self-awareness and self-expression abilities), (b) interpersonal (i.e., social awareness, awareness of others’ feelings or cooperative relationship building), (c) stress management (i.e., capacity to manage and regulate emotions), (d) adaptability (i.e., situational coping, flexibility, and problem solving), and (e) general mood (i.e., emotional competence needed to achieve one’s goals). Raw scores were tabulated and converted into standard scores based on a mean standard score of 100 and a standard deviation (SD) of ±15 (Bar-On, 2002). According to Bar-On (2002), scores within one SD of this mean suggest effective emotional and social functioning. Scores one SD or more above the mean (>115) indicate well developed skills for that particular scale. Scores falling one SD or more below the mean (<85) are considered areas in need of improvement. The EQ-i:S is a consistent, stable, and reliable instrument with an internal consistency of 0.97 and test–retest reliability of 0.72 for men and 0.80 for women (Bar-On, 2006).
The SALI is a measure of leadership characteristics, where leadership is defined as the process of influencing the behaviors of other individuals in their efforts toward goal setting and achievement (Smola, 1988). Respondents rated each of the 40 items as they relate to their leadership characteristics on a five-point Likert scale from 1 (usually do not behave in this manner) to 5 (almost always behave in this manner). A possible total score ranged from a low of 40 to a high of 200. A higher total score indicates high self-assessment of leadership characteristics. Reliability testing produced a Cohen’s kappa coefficient of 0.54. The SALI was able to discriminate on leadership ability between groups (Smola, 1988).
Generic caring, the degree of a person’s ability to care for others, was measured by the CAI (Nkongho, 2003). This questionnaire is based on Mayeroff’s (1971) definition of caring: “helping another grow and actualize himself…a process, a way of relating to someone that involves development” (p. 1). The questionnaire consists of 37 items with a seven-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Higher scores indicate a greater degree of caring. The CAI has three subscales: Knowing (CAI_K, 14 items; score range, 14 to 98), Courage (CAI_C, 13 items; score range, 13 to 91), and Patience (CAI_P, 10 items; score range, 10 to 70). The CAI is a reliable measure of caring with internal consistency on the total CAI, ranging from 0.79 to 0.84, and a test–retest reliability of 0.75 (Nkongho, 2003). Construct validity was supported by its ability to discriminate between students and nurses and between women and men (Nkongho, 2003).
The Caring Dimensions Inventory (CDI-35) was designed to ascertain nurses’ perceptions of what represents caring in nursing and includes psychosocial, professional, technical, and organizational aspects (Watson, Deary, & Lea, 1999). Following the stem question, “Do you consider the following aspects of your nursing practice to be caring?” the respondent is asked to rate 35 nursing activities on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) (Watson, Deary, & Hoogbruin, 2001). The higher the score, the more likely the nurse considers these behaviors to be caring. A most recent study of this tool noted an intrarater reliability of 0.67 (Watson, 2003). An earlier study (Watson & Lea, 1997) using the original instrument (CDI-25) showed an internal consistency of 0.91. Content validity was addressed through an extensive literature review (Watson & Lea, 1997). In the present study, a general caring score was determined by totaling the responses from 22 items that weighed on one factor, specifically “general caring in nursing,” when factor analysis was performed (Lea, Watson, & Deary, 1998, p. 665).
The results for all measures were evaluated for fit with a normal distribution. Repeated measures analysis of variance (ANOVA) was used to evaluate the change in each variable over T1, T2, and T3. Post hoc contrasts were used to determine the location of any significant differences. Pearson’s coefficients were calculated to determine the correlation of changes (T1 to T3) in EQ-i:S with changes (T1 to T3) in each of the other measures (SALI, CAI, and CDI). For all analyses, the SPSS PASW statistical package, version 18, was used, and alpha was set at p < 0.05.
A baseline cohort of 76 nursing students agreed to participate in the study. Of these, 52 completed the questionnaires at all three time periods for an overall follow-up rate of 68% (Table 1). The students’ previous highest levels of education were high school (n = 43), professional certificate (n = 4), and baccalaureate degree (n = 5). At T2, 13 students were lost to follow up. Four had withdrawn from the program and nine did not respond or were no longer interested in participating. At T3, an additional five students were lost to follow up, and six students were delayed in their program and not tested.
Table 1: Emotional Intelligence Study Characteristics of Participants
The scores for each instrument or instrument subscale at T1, T2, and T3 are presented in Table 2. The Total EI mean scores were within the effective functioning range (85 to 115). No statistically significant changes in Total EI from T1 to T2 or to T3 were noted. The Figure illustrates the T1, T2, and T3 scores for each subscale of the EQ-i:S. The only statistically significant improvement in score occurred in the Adaptability subscale, with an increase from T1 to T2 and from T1 to T3 (p = 0.03).
Table 2: Measures of Emotional Intelligence, Leadership, and Caring Over Three Time Periods
Figure. Emotional Quotient Inventory: Short version scores (total and subscales) for times 1, 2, and 3 (T1, T2, T3). Intra = intrapersonal subscale; Inter = interpersonal subscale; Stress = stress management subscale; Adapt = adaptability subscale; Mood = mood subscale. Horizontal lines represent effective functioning range for emotional intelligence as defined by Bar-On (2002). Only the Adaptability subscale score showed statistically significant improvement from T1 to T2 and from T1 to T3 (p = 0.03).
The only other statistically significant changes occurred in CAI_C and CDI (Table 2). Post hoc contrasts revealed that for both measures, statistically significant improvements in scores from T1 to T2 and from T1 to T3 (p = 0.04 and p = 0.02, respectively) were noted, but no change was noted from T2 to T3.
Table 3 presents the correlations among changes in EI and changes in the SALI and CAI subscales and CDI. Statistically significant positive correlations among changes in total EI and changes in SALI, CAI_K, and CAI_C were noted.
Table 3: Correlation Between Change in EQ-i:S Scores and Change in Leadership and Caring Scores from Baseline to the End of the Program
This is the first known longitudinal study of EI among nursing students. The results indicate there was little change in EI, leadership, and caring of nursing students over their 4-year undergraduate program. The only significant changes noted were the EI adaptability subscale score, the caring CAI_C subscale, and the CDI (professional caring). These scores improved from T1 to T2 but had not changed any further by T3. Students did not achieve maximum scores on any of the measures. In spite of the small mean changes in all scores, the change in overall EI (total score) was positively correlated with changes in leadership (SALI) and caring (CAI_K and CAI_C).
Perhaps there was little change in EI in this study because of the relatively high baseline values of the students. The mean EQ-i:S scores at all time points were within the effective functioning range of EI as defined by Bar-On (2002) (Figure). The profession of nursing likely attracts individuals with effective EI (i.e., individuals interested in the welfare of others). Moreover, individuals who successfully compete for admission may have higher EI than those not accepted into health professional programs. If students are currently in an effective functioning range (EQ-i:S: 85 to 115), is there any advantage to increasing this to the enhanced functioning level (EQ-i:S > 115)? Bar-On (2002) has indicated that individuals with enhanced EI are exceptionally effective, both emotionally and socially, in all aspects of their lives and are usually successful in achieving their goals. Although EI has been correlated with the clinical performance of both nurses (Codier, Kooker, & Shoultz, 2008; Morrison, 2008) and nursing students (Beauvais et al., 2011), no studies have examined the added value of obtaining enhanced EI skills. Codier et al. (2008) reported higher EI scores in older nurses. Thus, it may be that EI will change more with clinical experience than with education. More research is required to identify the level of EI needed for effective clinical practice.
The only EI subscale that was significantly changed over the course of the program was the Adaptability scale, which Bar-On (2002) stated reflects one’s ability to be “flexible, realistic, successful in managing change, and adept at finding effective ways of dealing with everyday problems” (p. 16). In addition, it reflects one’s ability to look at problems from different angles, set realistic goals, and have adequate ability to approach difficult tasks or situations realistically and resolve them in a systematic well thought-out manner (BarOn, 2002). The students’ involvement in a self-directed, student-centered, problem-based learning program may have influenced the changes observed. Students are initially apprehensive about an unfamiliar way of learning but become comfortable examining scenarios, formulating issues to be explored, and finding and reporting their new knowledge.
Although there was no change in the mean students’ leadership scores over the course of the program, positive correlations were found between changes in total EI (EQ-i:S) and changes in leadership. The change in EI explained approximately 25% of the variance in the change in leadership. Many of the behaviors included in the leadership tool are also behaviors reflective of EI (e.g., awareness of how you communicate with others, listening attentively for meaning and feelings, awareness of the perceptions of others, showing a willingness to make changes, striving to understand other people, looking for ways to improve yourself, encouraging others). Other articles (Akerjordet & Severinsson, 2010; Wessel et al., 2008) have reported positive correlations between EI and leadership, but the current study is the first to examine the correlation between the changes in both.
The changes in the caring scores (CAI_C and CDI) in the first 2 years of the program could be a result of both the academic and clinical experiences of the students. Caring is a significant focus in the initial years of the program, with much discussion of both the scientific and humanistic aspects of caring. The small group learning environment, with emphasis on mutual respect and facilitating the group process, may also contribute to change in caring. Simmons and Cavanaugh (2000) reported that after initial CAI scores, the strongest predictor of caring of nursing graduates was a “caring school climate.” In addition, students had completed their first full year of acute care clinical nursing by T2, and experiences with patients would give them direct experience with caring.
The relationship between measures of EI and leadership and EI and caring could be due to a true cause–effect; that is, an improved EI contributes to changes in leadership ability and caring. On the other hand, there may be an overlap in the constructs. Herbert and Edgar (2004) noted that many of the leadership skills, such as facilitation, negotiation, open communication, collaborative relationships, and strong informal relations, were skills directly related to EI. The CAI_K sub-scale includes knowing one’s strengths and limitations and understanding the needs, strengths, and weaknesses of the person being cared for (Nkongho, 2003). These descriptors of CAI_K (and the associated questionnaire items) are similar to the descriptors associated with the EI intrapersonal and interpersonal subscales. More recently, Akerjordet and Severinsson (2010) reported on the confusion related to the concept of EI, the multitude of qualities attributed to the concept, and the lack of rigorous studies on the construct.
Emotional intelligence changes little over the course of a nursing program. If improving the EI of nursing students is considered important, then specific intervention strategies should be introduced into the educational program. The fact that changes in EI were related to some aspects of caring and changes in leadership suggests that improving the EI of nursing students may be a reasonable objective. However, the level of EI functioning required for professional nursing practice is unclear. It may be more important to assess EI as either part of the admission criteria (Brewer & Cadman, 2000) or on entry to the program so that specific EI interventions can be offered to those with lower EI scores.
Changes in EI and caring seemed to occur early in the program (within the first 2 years or following the first year of clinical experiences). This is likely an important time to assess these attributes and include educational strategies to increase EI, as well as caring behaviors.
The limitations of our study are related to the sample size. Only 14% of the total cohort of students entered and completed the study, and all students were volunteers. Thus, the sample may not be representative of the entire class. Even if the results reflect the EI, leadership, and caring of the entire group, they may not be generalizable to nursing programs that do not follow problem-based learning curricula. However, it is unlikely that a larger sample size would have provided more significant results because the effect sizes, as estimated by the partial Eta squared from the ANOVA, were very small (ranging from 0.005 for CAI_P to 0.073 for the CDI).
The measures used in this study will also affect the results. All measures were self-report questionnaires, and thus only reflect the individual’s view of their own EI, leadership, and caring. Results could be different if we used instruments that involved observation of behavior or opinions of others, such as coworkers or patients.
Our first research question was to determine the changes in EI, leadership, and caring in undergraduate nursing students throughout their program. Overall EI (Total EQ-i:S) did not change during the 4 years of the study. Adaptability EI and the courage aspect of caring (CAI-C) increased over time, and students identified more nursing activities as involving caring (CDI). Our second research question was to determine whether there was a relationship between changes in EI and changes in leadership and caring from the beginning to the end of the nursing program. Although EI (Total EQ-i:S), leadership (SALI), and knowing aspects of caring (CAI_K) did not change significantly over the program, the change in total EQ-i:S was related to changes in SALI, CAI_K, and CAI-C. Further research is required to determine whether curricular interventions targeted at increasing EI will result in improved leadership and caring skills in nursing students.
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Emotional Intelligence Study Characteristics of Participants
|No. at Time 3||Men/Women||Mean Age (SD)|
|Study participants (n = 52)||5/47||20 (4.1)|
|Entire class (N = 385)||30/355||20 (3.5)|
Measures of Emotional Intelligence, Leadership, and Caring Over Three Time Periods
|Time 1a||100.1 (13.8)||112.6 (18.9)||76.8 (9.2)||64.2 (9.5)||60.0 (5.5)||96.8 (18.1)|
|Time 2b||103.1 (13.8)||115.5 (17.2)||78.5 (8.7)||66.7 (9.5)||60.4 (5.1)||103.0 (7.3)|
|Time 3c||101.6 (14.7)||118.1 (16.8)||77.7 (9.2)||66.9 (8.7)||61.3 (4.2)||102.0 (10.9)|
Correlation Between Change in EQ-i:S Scores and Change in Leadership and Caring Scores from Baseline to the End of the Program
|EQTOT 1.6±11.4 (r)||0.505||0.541||0.574||0.169||0.116|