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Journal of Psychiatric and Mental Health Nursing, 2010, 17, 940–948

Research in brief




Submissions address:

Gary Winship

University of Nottingham, Jubilee Campus,
Nottingham, NG8 1BB, UK

Is emotional intelligence an important
concept for nursing practice?
Background and significance
Emotional intelligence is the ability to process
emotions, more specifically the ‘perception, assimilation, understanding, and management of
emotion’ (Mayer & Cobb 2000). Extensive
research outside of nursing practice has demonstrated correlations between measured emotional
intelligence and important workplace and workforce outcomes such as performance, leadership
effectiveness, job retention, stress management, job
satisfaction, burnout prevention and positive conflict styles. In several dozen nursing research
studies, pilot data have demonstrated similar outcomes, correlating measured emotional intelligence
with levels of nursing performance in both clinical
nursing staff and nursing leaders, retention of
clinical nurses, stress adaptation, professional
achievement, job satisfaction, organizational citizenship and selected positive clinical outcomes in

Literature review
The nursing research literature on emotional intelligence has grown over the past decade to include
nursing studies that focus on emotional intelligence
and leadership, clinical practice, nursing education,
patient outcomes, stress and burnout, nurse retention and professionalism. Studies on emotional
intelligence and leadership outcomes have provided
evidence for the importance of emotional intelligence skills for effective nursing leadership (Molter
2001, Vitello-Cicciuo 2002, Cummings et al.
2005). Studies have explored the relationship
between emotional intelligence and coping, stress
management, hardiness, conflict style, burnout,
nurses health and professionalism (Tjiong 2000,
Humpel et al. 2001, Budnik 2003, Farmer 2004,
Gertis et al. 2004, Cummings et al. 2005, Kooker

et al. 2007, Montes-Berges & Augusto 2007,
Augusto-Landa et al. 2008, Deshpande & Joseph
2009). A number of studies have examined emotional intelligence in nursing students, academic satisfaction and both academic and early professional
success (dos Santos 1999, Rochester et al. 2005,
Shanta 2007). Measured emotional intelligence has
been demonstrated to correlate with both performance and job retention (Budnik 2003, Codier
et al. 2008, 2009). Emotional intelligence has been
examined in mental health nurses (Humpel et al.
2001, Akerjordet & Severinsson 2004) and several
clinical studies have examined its role in diabetes
and HIV medication compliance (Samar 2001,
Willard 2003). What is lacking in the literature is
research on nursing teams, and intervention studies
that explore methodologies to improve emotional
intelligence abilities in nurses.
One study used emotional intelligence as a
framework to examine 16 stories about nurses to
better understand nursing workforce issues (Kooker
et al. 2007). Other studies similarly have utilized
emotional intelligence as a theoretical framework
for research on nursing practice issues. Little
nursing research exists on the concept of emotional
intelligence itself and the conceptual relevance of
emotional intelligence to nursing practice is not
clear (Akerjordet & Severinsson 2004). Further,
there is no consistent model of emotional intelligence used among the various nursing research
studies done to date.

Purpose and research questions
The purpose of this mixed methodology, exploratory study was to identify and describe evidence
of emotional intelligence attributes in 75 stories
written by nurses about nursing. The attributes
were further explored as they related to three concepts important to the profession of nursing: professionalism, performance and nursing intuition.
The researchers focused on the following specific
research questions:
© 2010 Blackwell Publishing

Emotional intelligence in nursing

Study question #1: emotional intelligence
Is evidence of emotional intelligence found in the
stories? If so,
(#1a) Which attributes of emotional intelligence
were found?
(#1b) Which attributes occur most frequently?
(#1c) Do groupings of attributes appear?
Study question #2: professionalism
Is there a correlation between attributes of emotional intelligence and nursing professionalism?
Study question #3: performance
Is there a correlation between attributes of emotional intelligence and performance scores?
Study question #4: intuition
Is there a correlation between attributes of emotional intelligence and the subjectively identified
presence of nursing intuition in the stories?

Conceptual models of emotional intelligence
As a concept, emotional intelligence emerged from
decades of intelligence research about the relationship between thinking, feeling and performance
abilities which, before 1990, were not considered to
be related (Akerjordet & Severinsson 2004). Three
main models of emotional intelligence have been
used in the research done to date. The models differ
three ways: the setting in which the concept was
developed, the definition of the concept utilized and
the instrumentation used for measurement.
One model of emotional intelligence emerged in
the community health setting. It defines the concept
as a function of personality attributes, and measures emotional intelligence with a self-report
instrument. What is often called the personality
model of emotional intelligence was developed by
Dr Reuven Bar-On, an Israeli psychologist interested in the concept of ‘happiness’. Working in a
community mental health setting in South Africa,
Dr Bar-On identified what he called ‘emotional
quotient’, a measurable phenomenon related to
happiness and other important physiological and
psychological wellness outcomes. Dr Bar-On
changed the name of this concept to ‘Emotional
Intelligence’ after this later term began to be used
widely. He devised the EQ-i, an instrument for measuring emotional intelligence, which consists of selfreport measures that determine a total emotional
intelligence score and 18 sub-scores. Limitations of
© 2010 Blackwell Publishing

this instrument include those of any self-report
instrument. Test results are only as reliable as the
accuracy of the individual’s self-assessment abilities. When tested for validity and reliability, the
EQ-i was found to overlap with several traditionally used personality instruments. This raises face
and discriminant validity concerns for both the
instrument and the concept model (Brackett &
Mayer 2004). This model is often referred to as the
Personality Trait Model of emotional intelligence
because of its primary emphasis on emotional intelligence as an aspect of personality (Bar-On 2007).
A second model of emotional intelligence
emerged in the academic research setting. It defines
the concept as an ability, and measures emotional
intelligence with a skill performance instrument. Dr
John Mayer and Dr Peter Salovey, cognitive psychologists at the University of New Hampshire, first
used the term ‘emotional intelligence’ describing
individuals who demonstrate the ability to use
emotions to facilitate reasoning processes. This
emotional ability includes the following ability subcategories: (1) correct identification of emotions in
self and others; (2) use of emotions to facilitate
reasoning; (3) understanding of emotions in self and
others; and (4) management of emotions in self and
in emotional situations. These four abilities constitute the operational definition of emotional intelligence for the ability model. This model is measured
using the ‘MSCEIT’ (Mayer, Salovey, Caruso Emotional Intelligence Test), an ability test which
requires the performance of emotional tasks. The
MSCEIT has had rigorous evaluation over 15 years,
several major revisions, and has demonstrated
validity and reliability (Brackett & Mayer 2004,
Mayer et al. 2008).
A third model of emotional intelligence has
been used widely by organizational consultants. It
defines the concept as a blend of traits and abilities,
and measures emotional intelligence using the
assessment of others. In 1995, Dr Daniel Goleman
published the blockbuster book, ‘Emotional Intelligence’. Dr Goleman proposed a ‘mixed’ model of
emotional intelligence which includes both emotional abilities and personality traits. This model
has been widely used in organizational settings, and
measures emotional intelligence using the ‘ECI’, a
360-degree instrument which relies on assessments
of an individual done by their supervisor, their
employees and their peers. Criticisms of this instrument include concerns about bias associated with
assessments done within an organizational hierar941

E. Codier et al.

Table 1
Emotional intelligence: comparison of three models

Personality model

Ability model

Mixed model

Definition of

Emotional and social facilitators
that influence intelligent
behaviour (Bar-On 2007)

Context of origin

Community health
Face validity and discriminant
validity issues related to
overlap with personality tests

‘The ability to perceive and
express emotion, assimilate
emotion in thought,
understand and reason with
emotion, and regulate emotion
in the self and others’ (Mayer
et al. 2000, p. 396)
Cognitive psychology research
Good face and discriminant

‘The capacity for recognizing our
own feelings and those of
others, for monitoring
ourselves, and for managing
emotions in ourselves and in
our relationships’ (Goleman
1995, p. 317)
Organizational development
Face validity and discriminant
validity issues related to
overlap with personality tests

Mayer et al. (2008).

chy, as well as construct and discriminant validity
issues related to overlap with personality instruments (Brackett & Mayer 2004, Mayer et al.
2008). A comparison of the three models of emotional intelligence is summarized in Table 1.

Emotional intelligence in nursing
Emotional intelligence has emerged in the last two
decades as a concept of interest to nursing workforce developers, nurse educators and to clinical
practitioners. The nursing research reflects use of all
three models, but the ability model has been used
most frequently. All three models reflect attributes
such as self-awareness, self-management, social
awareness and social/relationship management, and
were evaluated for use in this study. Three questions
were used to guide model selection. During model
selection the research team asked the following
questions: Which model is easiest to use in evaluating the stories? Is the model compatible with narrative data? Can the model capture elements of the
emotional labour intrinsic to nursing? Evaluation of
the models using the three questions is summarized
as follows:
Ease of use was one of the most important
factors for model selection. During a trial of story
scoring, identification of emotional intelligence
attributes proved easiest using the personality
model’s operational definitions. It was more difficult to identify attributes using the ability and
mixed models’ operational definitions. When evaluating a story, nursing ‘traits’ were easier to identify
than nursing ‘skills’.
Model compatibility with narrative data was
also important. The self-reporting nature of autobiography was compatible with the stories dataset.

The ‘self-reporting’ elements of the personality
model best reflected this congruence.
Model capture of emotional labour elements
proved most difficult. Nursing performance
requires emotional skills. These skills are evidenced
in what is sometimes called the ‘emotional labor’ of
nursing. Although personality traits affect performance, the emotional labour of nursing is a learned
ability. This observation argued against use of the
personality model.
Weighing the three criteria, the study investigators were influenced largely by utility and methodology issues and selected the personality model.
This model’s subcategories and operational definitions are summarized in Table 2.

Nursing concepts: professionalism,
performance, nursing intuition
In addition to identifying attributes of emotional
intelligence in the stories, the research team became
interested in relating emotional intelligence
attributes to concepts central to nursing practice.
The team chose the following: professionalism,
performance and nursing intuition.
Professionalism is defined in nursing in a variety
of ways. For the purposes of this study, the
researchers used it to reflect the development of role
maturity, particularly in terms of increasing scope
of practice. In early stages of growth, the nurse may
have the greatest emphasis on the technical aspects
of practice. The nurse, with maturation, begins to
include more comprehensive relationships with
patients and their family system, as well as collegial
and team relationships. Nurses, with growth and
maturity may become involved in broader issues in
their clinical area, in the larger institution within
© 2010 Blackwell Publishing

Emotional intelligence in nursing

Table 2
Elements of emotional intelligence (personality model)

Operational definition

Emotional self-awareness
Social responsibility
Interpersonal relationships
Reality testing

Respect for and accept of one’s self
Recognition of one’s feelings and what caused them
Expression and defense of feelings, beliefs and thoughts and rights in a non-destructive way
Self-direction and self-control, emotional independence
Realization of potential capabilities
Awareness of, understanding and appreciation of the feelings of others
Cooperation, constructive and contributing membership in a social group
Making and maintaining positive relationships and a positive work environment
Assessment of differences between what is being experienced and what is objectively
Adjustment to a changing situation
Identification of problems and possible solutions
Adaptation and coping in the midst of stress
Delaying or resisting an impulse
Looking at the bright side, maintaining a positive attitude
Satisfaction with life, the ability to enjoy self and others

Problem solving
Stress tolerance
Impulse control
Bar-On (1997).

which they practice, and in local, regional, national
or international nursing. To measure professionalism, the research team devised a Likert scale which
reflected a continuum of scope of practice.
To operationalize performance, the team selected
Benner’s concept of ‘novice to expert’. This
describes performance development from the early
years of mentored practice to later functioning as
an independent content expert who mentors and
teaches others (Benner 1984). To measure performance, a Likert scale based on Benner’s definitions
of novice to expert performance was used.
The third concept chosen was nursing intuition.
The concept of nursing intuition has been articulated and explored in nursing research throughout
the last few decades. Although there is no consensus
definition, it is generally described as a complex
interaction of relational, experiential, knowledge
and awareness attributes. The ‘knowing’ aspect of
intuition consists of both fact knowledge and
understanding that is not represented in traditionally understood linear reasoning processes (Rew &
Barrow 1987; King & Appleton 1997). Nursing
research has demonstrated correlations between
intuition and clinical judgment, effective decision
making and crisis aversion (Cioffi & Markham
1997; McCutcheon & Pincombe 2001). Benner
described intuition as a characteristic of expert
nursing practice and a primary component of
skilled performance (Benner et al. 1996). Other
researchers provided evidence that intuition is
not exclusively found in expert nurses (English
1993; McCormick 1993; McCutcheon & Pincombe
© 2010 Blackwell Publishing

This study used a purposive sample, a mixed methodology consisting of an emergent, content analysis
design (Downe-Wambolt 1992) and quantitative
data analysis. The study utilized 75 nursing stories
that were reviewed by a research team consisting of
four nurses. The content analysis design was selected
because story analysis can be used to identify elements of practice difficult to identify in more empirically focused research (Berman et al. 1998). The
stories were written by nurses and focused on memorable experiences that reflected the essence of
nursing. The stories were collected and published in
2009. Each author provided written permission for
their story to be used. The anthology editor provided
written permission for the stories to be used in the
study. No author names or identifying information
were included in the data.
The source of the stories was a recently published
book that contained inspirational stories about
nursing written by nurses (Heacock 2008). The
author of the book solicited stories from nurses by
e-mail, asking, ‘Do you have an inspirational story
about nursing?’ Her book summarized 75 stories
across many different disciplines and nursing roles.
Although specific demographic information about
the authors of each story was not available, it was
clear from story content that a wide range of age,
gender, experience, clinical setting and culture were
represented. Out of the 75 authors, two self943

E. Codier et al.

identified as male. A range of age and experience
was evident in the stories, from new grads to nurses
in the later years of their career. Medical surgical
nurses and intensive care nurses were included, as
were nurses in the community, school and mental
health settings.
As the study design emerged, study procedures
evolved. The first phase of the study involved identification of the presence of emotional intelligence
attributes in the nursing stories. Once it became
clear that attributes were present, the research team
chose to add to the procedures a second phase in
which the stories were examined for evidence of the
following three nursing concepts: professionalism,
performance and nursing intuition. Once it became
clear that these concepts were also easily identified
in the stories, a third phase was included in the
study, in which correlations between emotional
intelligence attributes and the three nursing concepts were explored.
In the first phase of the study procedures, stories
were independently scored by each study investigator using specific scoring criteria for each study
question. Specific scoring definitions and criteria
were used for criteria 1–3 (emotional intelligence
attributes, professionalism and performance). The
fourth criterion, nursing intuition, required a subjective evaluation. During a pilot of scoring procedures, interrater reliability between the study
investigators was found to be high.
The research team compared individual scoring
with a second scoring procedure. In the second
procedure, individual scoring was followed by
group evaluation of the stories and their scores.
There was consensus in the study group that this
was a preferable procedure. For that reason, a
second step in the scoring procedures developed in
which final scores were determined after group
sharing and discussion of individual scores. For
criteria 1 and 4, the final score was determined by
scoring agreement of three out of the four investigators. Criteria 2 and 3 used averaged scores from
the four researchers to determine final scores.
Stories were evaluated and scored using the
following criteria and operational definitions:
Criterion 1. Presence of emotional intelligence
attributes (study question #1a–c)
Scoring of this criterion consisted of a count of the
number of emotional intelligence attributes found

in each story. The attributes for emotional intelligence were operationalized using the 18 emotional
intelligence attributes in the personality model (see
Table 2). Data were gathered using frequency distributions. In addition to individual story scoring,
the total attributes found in each story were tallied
in a total frequency distribution for all the
attributes found in all the stories.
Criterion 2. Professionalism (study question #2)
This criterion focused on scope of nursing practice
as illustrated in the stories. Each story was scored
using the following 1–5 Likert scale developed by
the study investigators: (1) the story illustrates that
the nurse is focused on technical procedures; (2) the
story illustrates professional focus beyond the
technical; (3) the story illustrates that the nurse is
focused on meeting job objectives; (4) the story
illustrates superior performance which includes
team and unit activities; and (5) the story illustrates
superior performance which encompasses patient
care, the nursing unit and institution, and/or
involvement in many levels of practice.
Criterion 3. Performance (study question #3)
Performance was scored using a Likert scale of 1–5.
The operational definition for this scale was based
on Benner’s definitions of novice to expert nursing
practice, which focuses on performance independence. The following operational definitions for
the 1–5 Likert scale were used: (1) new graduate;
(2) competent nurse still requiring supervision; (3)
competent nurse functioning independently; (4)
competent nurse, functioning independently and
serving as mentor; and (5) highly competent nurse,
functioning as a subject matter expert (Benner
Criterion 4. Evidence of ‘nursing intuition’ (study
question #4)
This criterion was graded solely on the subjective
response of each researcher in response to the question, ‘Did the story reflect the nurse’s use of intuition?’ This criteria was graded with only ‘yes’/‘no’
Data were collected for each story on data sheets
completed by each researcher on each nursing story.
Once this phase of data collection was completed,
the study researchers met as a group to evaluate the
data. During these meetings, each story was read
out loud and each researcher’s scoring was shared
and discussed. Discussion focused on the opera© 2010 Blackwell Publishing

Emotional intelligence in nursing

tional definitions of each criterion as applied to the
individual stories. After discussion, each story
received a final score. For criteria 1 and 4, the final
score was determined by a 75% agreement of the
study investigators. For example, for ‘empathy’ to
be included in a story’s final scoring, three out of
the four investigators must have agreed upon its
presence in the story. In addition to the scoring for
each individual story, data were collected on the
frequency of appearance for each emotional intelligence attribute across all nursing stories. For criteria 2 and 3, final scores were determined by the
averaging of the four researcher’s numerical scores.
Descriptive analysis was performed using average
scores, frequency distributions and percentage
scores. Correlation analysis was performed between
study variables.

Quantitative data were collected for the study. Data
analysis included both descriptive and inferential
statistics. Results from the data analysis, organized
according to the study research questions, is as
Study question #1a
Was there evidence of emotional intelligence in the
stories? A total of 280 attributes of emotional intelligence were found in the 75 stories. All but two
nursing stories illustrated at least one emotional
intelligence attribute. The number of attributes per
story ranged from 1 to 10, with an average of 4 per
story. The number of attributes found per story is
summarized in Table 3.

Table 3
Emotional intelligence attributes: frequency of occurrence


Frequency of
(75 total stories)

Problem solving
Emotional self-awareness
Social responsibility
Interpersonal relationships
Stress tolerance
Reality testing
Impulse control


Table 4
Number of emotional intelligence attributes per story
Number of attributes per

Number of stories in which
this number of attributes
occurred (out of 75 stories)




Study question #1b
Which attributes of emotional intelligence were
found in the nursing stories? All 18 emotional intelligence attributes were illustrated in at least one
story. The frequency with which each attribute
appeared is summarized in Table 4. Empathy, emotional self-awareness and problem solving occurred
most frequently. Impulse control, assertiveness and
reality testing occurred least frequently.

0.05) and impulse control (P < 0.05). Independence
correlated with problem solving (P < 0.01), stress
tolerance (P < 0.05), self-regard (P < 0.05) and
assertiveness (P < 0.05). Self-regard correlated with
self-actualization (P < 0.01), assertiveness (P < 0.05)
and independence (P < 0.05).
In the frequency analysis, the attributes which
occurred most frequently in pairs were empathy/
problem solving, empathy/emotional self-awareness
and problem solving/emotional self-awareness.
Two sets of three attributes also occurred
repeatedly: empathy/emotional self-awareness/
interpersonal relationships, and empathy/emotional
self-awareness/problem solving.

Study question #1c
Did emotional intelligence attributes occur in
groups? Of the 13 pairs of attributes that occurred
together more than once, 11 correlated significantly.
Problem solving correlated with independence (P <
0.01), flexibility (P < 0.01), self-actualization (P <

Study question #2
Is there a correlation between emotional intelligence attributes and level of professionalism? The
average score for professionalism was 3.8. Of the
study stories, 10 (30%) received a score of 2 or
below, 26 (35%) a score of 3, 30 (40%) a score of

© 2010 Blackwell Publishing


E. Codier et al.

4 and 9 (12%) a score of 5. High professionalism
scores correlated with the number of emotional
intelligence attributes found in the story. The
greater the number of attributes found, the higher
the professionalism score. The following six
attributes correlated at a significant level (P < 0.01)
with high levels of professionalism: emotional selfawareness, empathy, social responsibility, interpersonal relationships, problem solving and stress
Study question #3: performance level
The average performance score was 3.7. Of the
study stories, 16 (21%) received a score of 2 or
below, 26 (35%) a score of 3, 25 (33%) a score of
4 and 8 (11%) a score of 5. The number of
attributes in the stories correlated significantly (P <
0.01) with performance scores. Stories with the
highest number of emotional intelligence attributes
also demonstrated the highest scores on the novice
to expert scale. The following attributes correlated
significantly (P < 0.01) with performance scores:
empathy, social responsibility, interpersonal relationships, problem solving and stress tolerance.
Study question #4
Is there a correlation between attributes of emotional intelligence and nursing intuition? Intuition
was identified in 14 (19%) of the stories. It correlated (P < 0.01) with the following attributes:
empathy, interpersonal relationships and emotional
self-awareness. Intuition correlated significantly
(P < 0.01) with performance level but not with

Conclusions, limitations and implications
for nursing
Attributes of emotional intelligence were found to
be present in the nursing stories. Empathy, problem
solving, interpersonal relationships and emotional
self-awareness occurred most frequently and correlated with professionalism, performance level and
intuition. It is notable that the two stories in which
no emotional intelligence attributes were found also
had the lowest scores possible for professionalism,
performance and nursing intuition. The frequency
with which attributes were identified in the stories
and their correlation with professionalism, performance level and nursing intuition provides evidence
for the importance of emotional intelligence to
nursing practice.

Nursing intuition was identified in 19% of
the stories and correlated with three emotional
intelligence attributes; empathy, interpersonal relationship and emotional self-awareness. Intuition
correlated with performance scores, which supports
previous research on the relationship between
expert practice and intuition. No correlation was
demonstrated between intuition and professionalism as it was operationalized in this study. These
findings may be useful for further conceptual exploration of nursing intuition.
A limitation of the study is the face and discriminant validity of the emotional intelligence
model used. The emotional intelligence model
used for this study was selected primarily for
reasons of utility. The emotional intelligence
attributes were easy to identify in the nursing
stories. Attribute operational definitions were clear
and using them in the scoring process resulted
in high interrater reliability. Further research is
needed on the ‘trait’ and ‘ability’ aspects of emotional intelligence as they apply to nursing practice. For conceptual clarity, it is important to
utilize a model of emotional intelligence which has
demonstrated validity and does not overlap with
other concepts. It is important that the model used
reflects the emotional labour which is intrinsic to
nursing work. For that reason, further research
into the ability model and its conceptual application to nursing practice is recommended.
Emotional intelligence is a new concept in
nursing. Preliminary nursing research findings
provide pilot data which are similar to the findings
of emotional intelligence research in other professions, but little conceptual research has been done
applying emotional intelligence to nursing practice.
The findings of this study suggest that emotional
intelligence is a concept which is not only identifiable in nursing practice but may also be related to
important nursing concepts such as professionalism, performance and intuition. Further nursing
research is needed to explore the model of emotional intelligence which is most appropriate for
nursing, as well as further investigation of the
attributes of emotional intelligence as they apply to
specific clinical practice outcomes.
Assistant Professor
University of Hawaii at Manoa
Honolulu, HI, USA
E-mail: codier@hawaii.edu
© 2010 Blackwell Publishing

Emotional intelligence in nursing

Pain and Palliative Care Department
The Queen’s Medical Center
Honolulu, HI, USA
Case Manager
Medical Branch
Tripler Army Medical Center
Honolulu, HI, USA
Staff Nurse
The Queen’s Medical Center
Honolulu, HI, USA
doi: 10.1111/j.1365-2850.2010.01610.x

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