Learning Activity week 4

111

10 Emotional Intelligence Across

the Professional Lifespan

INTRODUCTION

In this chapter, the four (EI) abilities, identifying, understanding, using and managing emotions are applied to nurses’ professional lifespan (Mayer et al., 1999). Their usual order is adapted to best align with the nursing process.

NURSING NOVICE TO EXPERT

EI Ability and the Benner Model

Research findings across many disciplines, including nursing, have dem- onstrated the relationship between emotional intelligence (EI) ability and job performance (see Chapter 15 for a research summary). At each level of nurse performance, from novice to expert, EI abilities support evolv- ing performance. Interpersonal and team abilities required in advanced stages, such as leadership, conflict management, and organizational change, similarly correlate with EI ability.

Story: Yell Just A Little (From a Nurse Leader Exercise Applying Experience to EI Theory)

I love nursing, and I think nurses are just the greatest people. My career has been so satisfying, in part because I get to hang around with these great people whose work I admire so much. In some ways, this was why I made a good nurse manager. My approach was collegial, supportive, and always focused on coaching and teaching. When there were performance issues or necessary confrontations with staff, it always had a coaching,

Copyright Springer Publishing Company. All Rights Reserved. From: Emotional Intelligence in Nursing DOI: 10.1891/9780826174543.0010

112 Emotional Intelligence in Nursing

positive tone. This was fundamental to my awareness of myself as a leader, and only grew as I matured as a leader.

However, there came a time when this approach just did not work. One of my staff was a capable but profoundly irritating nurse. She was loud, brash, and unhelpful. On our busy unit, she was disruptive. I re- ceived many complaints, as she was not a team player. The staff kept tell- ing me, “You have to yell at her,” but I could not imagine that being either possible or desirable. Looking back across a long management career, I laugh at how many times I was wrong about something when my staff was right. I wondered, what if they are right? I learned to trust that group wisdom. I did not know about EI at the time, but knowing about it now, I understand how EI abilities helped me through this difficult situation.

Applying EI

Using EI: Identifying Emotions I was confronted with disruptive behavior that did not respond to feed- back. I had assumed this nurse was uncaring and disrespectful of author- ity, but I also had to acknowledge that something about this situation was not adding up. At the bedside, her gentleness and caring with patients made her seem like a different person. Additionally, my leadership really worked for that unit—except for her. So, what if she was not in fact, feel- ing what I thought she was?

Using EI: Understanding Emotions and Using Emotions to Reason (“Think/Feel”) When emotional situations don’t “add up,” it is a red flag. This mental disconnect often results from incorrect assumptions. Understanding this, I reevaluated the situation. When emotions are used to reason, we “think/ feel,” combining data from our emotional experience with data from our cognitive experience. With this troublesome nurse, the result of a think/ feel process gave me several ideas. I accepted the possibility my assess- ment of this staff nurse’s feelings may have been inaccurate, so I also stopped blaming her and acknowledged my feedback was not working. Further, I explored my staff’s recommendation. Why did they want me to yell at her? Under what conditions would a raised voice be exactly what is needed?

It hit me like a lightning bolt. This nurse had grown up and lived most of her professional life in a patriarchal culture where animated exchanges, particularly about things of importance, often transpired in loud tones of voice. A loud voice indicated something was very important. In my own culture, the opposite was true. Growing up, the more important the issue,

Chapter 10 Emotional Intelligence Across the Professional Lifespan 113

the more hushed the tone of voice. Not so for my employee. That was what my staff had been trying to make me understand. The nurse simply could not “hear” my feedback.

Using EI: Managing Emotions I had to manage my own emotions differently. I needed to give feedback in a way this nurse could, literally, hear. I had to speak to this nurse in a firm, loud, authoritarian voice. I hated the idea. I was not sure I could do it, but I couldn’t see any other way.

I practiced again and again, right up to the hour of the appointment. The nurse came to my office. I said my planned three short sentence state- ment about her behavior that ended with, “and it must stop!” I was not yelling, but I was certainly loud. My voice was stern and I punctuated the last word with a slap of my hand on my thigh.

The nurse looked at me, startled. Her eyes opened wide, but she re- garded me as if she had not seen me before. She simply said, “Oh! Okay, I get it.” We went on to a topic she had wanted to talk about, a minor vaca- tion issue, in our normal tones of voice, as if the first part of our appoint- ment hadn’t happened.

Story Reflection

Although incredibly uncomfortable for me, I had found a way to be heard. The nurse’s behavior changed and the staff breathed a collective sigh of relief. Although I didn’t know about EI abilities at the time, in retrospect they made all the difference. What was escalating into a crisis in our unit took only basic EI ability to change the outcome. It was not complicated. It did not take a disciplinary action, a consultant, or a major intervention. We did not lose a valuable employee and team member. The unit did not become defensive or toxic and I learned a difficult lesson about communi- cation, leadership, and emotional assumptions about other people. Identi- fying emotions correctly, understanding them, using them to think about the situation, and managing emotions in this difficult situation made it possible to change the situation successfully.

EI APPLIED TO NURSE CAREER DEVELOPMENT

Using the Benner Model in Career Development

Benner’s model of clinical proficiency is useful for understanding how a nurse learns nursing, growing from novice through levels of expertise and experience to proficiency and expert practice. EI abilities support the

114 Emotional Intelligence in Nursing

developmental tasks needed to achieve each level and the developing skills that help nurses’ transition from one level to the next. This is par- ticularly evident when EI is applied to interpersonal, team, conflict, and critical thinking skills. The model is less helpful for understanding career development over the whole trajectory of a nurse’s professional life. Most nurses achieve proficient or expert levels of practice long before their ca- reer is over. To better explore how EI ability supports the entirety of a professional life span, a model from outside nursing is helpful.

Introduction to the Super Model

Nursing is often not simply a career choice, but a chance to integrate per- sonal values into a career choice. Multidisciplinary research provides evidence that such integration of personal values and career choices cor- relates with higher levels of life and career satisfaction. Donald Super’s Model of Career Development reflects this by integrating professional, personal, and developmental elements into career choice. Super’s model has several elements that apply particularly well to nursing. In all the stages that Super describes, EI abilities foster both tasks inherent to indi- vidual stages and to the work necessary to transition to subsequent stages (Super et al., 1996).

Growth Stage (Imagination and Skill Preparation) Super’s first stage, Growth, begins long before an actual career choice. The Growth stage is fueled by fantasy (imagining a career), interests, and curi- osity. Adults experience this stage as they envision a new career or make major career changes. They may be starting over in a totally new job, role, or work context, for which new skills, attitudes, interests, and social abili- ties must be developed. This happens when nursing is chosen by adults as a midlife career change.

Developmental career tasks in this stage include:

1. Shift of focus from the present to the future. 2. Increased control over life choices. 3. Self-motivation for both education and job training. 4. Self-management in work/study habits and attitudes (Super et al.,

1996).

EI Ability in the Growth Stage Nurses in the Growth stage may need new self-skills, interpersonal, group, team, or organizational skills when they change professional roles.

Chapter 10 Emotional Intelligence Across the Professional Lifespan 115

A former hedge fund manager who began nursing school at 40 attested to this! Research evidence demonstrates the role of EI ability in interper- sonal and intrapersonal skills, effective communication, emotional prob- lem-solving, and self-care within complex organizations.

One specific example of using EI ability in the Growth stage is man- aging fear, a natural part of the growth cycle. Beginning to focus on the future and trying something new and making a major life change can be scary. Understanding fear and learning to “think through it,” as well as making a plan for managing fear is important for success in the Growth stage. It may make the difference between being paralyzed by fear and being able to move forward.

Exploration (Education and Preparation) Exploration of a new career is characterized by (1) choice of career, (2) specific plans and goals, and (3) completion of education required for the career and -being hired at a first job. Future nurses in this stage take pre- requisite courses required for nursing school and become nurses’ aides or volunteer in a community care or hospital setting. By the end of this stage, nurses have completed nursing school and the first two stages of Benner’s clinical development. For adult nurses, making career changes such as a change in role, clinical specialty, or professional context (from a hospital setting to rural public health, for example), the same stage characteristics and developmental goals apply. Education necessary for the new career is been completed, an entry-level job achieved, and initial proficiency devel- oped (Super et al., 1996).

EI Ability in the Exploration Stage The developmental tasks of the Exploration stage, corresponding roughly to Benner’s Novice/Advanced Beginner, are daunting. Young people often leave home during this stage and experience new kinds of relationships, including collegial relationships. They begin academic programs such as nursing school, which require achievement of new individual, group, and clinical skills. In challenging programs like nurs- ing school, identification, understanding, and management of stress become very important. Achievement of this stage’s developmental goals requires acute and persistent self-awareness, self-evaluation, and self-management, as well as good relationships with peers, coworkers, mentors, and academic faculty. Nursing research (see Chapter 15) pro- vides evidence for the role of EI in self-efficacy, relationship effective- ness, interpersonal communication, stress management, resilience, and academic achievement. EI abilities clearly correlate with the three most important elements of nursing school—scholastic achievement, clinical

116 Emotional Intelligence in Nursing

performance, and nursing program completion—which makes them particularly important in this stage.

Establishment Stage (Frustration, Consolidating Skills, Increasing Responsibility) The Establishment stage is a long period that begins as the first job in a career that stabilizes, evolves, and often changes with career opportuni- ties and new interests. Themes in this stage include stabilizing, dealing with frustration, consolidating skills, and taking on new responsibilities.

Developmental tasks of this stage include:

1. Adapting to an organization and achieving basic competency. 2. Developing mature work habits: productivity, positive work atti-

tudes, coworker and team relationships. 3. Taking on new levels of responsibility.

This stage corresponds to Benner’s Proficiency stage. For some nurses, it corresponds to the Expert stage as well. For others, the Proficiency Stage may be their highest level of career performance (Super et al., 1996).

EI Ability in the Establishment Stage Performance in the Establishment stage, and completion of its develop- mental tasks, depends largely on EI abilities. Frustration generated from organizational complexity or dysfunction, obstacles to important goals, or thwarting of personal achievements can challenge adults in this stage. Adapting to changing organizational goals, managing conflicts between career and family life, and gaining increased levels of responsibility all require identification of emotions, understanding emotions, reasoning with them, and self-management. The body of nursing EI research reflects this. EI abilities correlate with constructive adaptation to change, positive approaches to conflict, successful teamwork, communication effective- ness, and prosocial organizational behaviors.

The transition from the Establishment stage (Super et al., 1996) to the next stage is rigorous for nurses and the need for EI abilities is particularly acute. The transition from Proficiency to Expert (Benner, 1984) most often requires expanding clinical practice and formalizing leadership and/or mentoring responsibilities. In this stage, nurses are often required to float to other clinical areas, increasing their clinical skills and adapting to dif- ferent teams and clinical environments. New leadership responsibilities often take the form of charge nurse duties, and orienting new employees similarly requires formal mentoring responsibilities. Participation in hos- pital committees may be required. For nurses new to these roles, the frus- trations ubiquitous to working with groups and organizations are often challenging. The new interpersonal and organizational skills required

Chapter 10 Emotional Intelligence Across the Professional Lifespan 117

are not always mastered. Some nurses, even after many years of practice, may not have clinical, leadership, or mentoring abilities necessary to ad- vance to this level.

Maintenance Stage (Holding, Updating, Stagnation, and Innovating) In Super’s Maintenance stage, a steady state has developed in the career. Themes of this stage have to do with requisite updating and innovating of skills as the work environment changes. Stagnation can occur without inno- vation and updating of skills. Nurses in stagnation, who have difficulty with new equipment, procedures, patient populations, or organizational goals, may begin to exhibit significant performance issues (Super et al., 1996).

EI Ability in the Maintenance Stage

In this stage, two trajectories are common: stagnation and adaptation, and EI abilities may determine which occurs. If a nurse can successfully nego- tiate changes on the unit, be aware of their feelings and those of others, understand their feelings within the context of the change, and think/ feel their way to a plan for adaptation, the nurse may adapt effectively to change. If these skills are not used, change resistance behaviors can arise resulting in both stagnated performance and sometimes a vicious cycle of negative feedback and negative performance reviews. Managing such employees can be challenging. Coaching these nurses to improve their EI abilities may be useful.

Disengagement Stage (Decelerating, Retirement Planning, Career Exit, and Retirement Living) Super describes Disengagement as the final stage of a career. Themes enumerated for this stage include slowing down, decelerating, retirement planning, and transition into retirement. The developmental goal of this stage is an exit from the career. In most disciplines, the gradual transition to retirement is often accompanied by adjustments in job expectations and focus. Deceleration of job responsibilities is expected.

This stage is often different for nurses. In nursing roles, a deceleration of job responsibilities may not be practical. A clinical nurse at the bed- side the day before they retire is expected to meet the same performance standards as any other nurse. A nurse manager typically works fully up until their day of departure. There also is an ethos in nursing that “once a nurse, always a nurse.” Retired people usually refer to their professional identities in the past tense, “I was a teacher,” “I was a firefighter.” But how often do you hear “I was a nurse?” Because of their propensity for

118 Emotional Intelligence in Nursing

integrating personal values fully into their professional identity, nurses commonly fuse their personal and professional identities, and even when not actively working after retirement, this often persists within the nurse’s self-concept. Nurses also often work beyond 65 and many who fully re- tire still maintain active nursing licenses. Even when fully disengaged from the nursing workforce, many retired nurses use their nursing skills in volunteer activities. This complicates the developmental tasks of the Disengagement stage.

EI AbIlIty In thE DIsEngAgEmEnt stAgE

Navigation of this last stage of a nurse’s career requires effective self- reflection and self-management, as well as navigation of closure, grieving, and relationship transitions. These are difficult challenges complicated by fusing of personal/professional identity. Collegial relationships in this stage provide support, feedback, reflection, and emotional self- management. Because of the important role of EI in effective communica- tion, interpersonal relationships, and personal emotional wellness, these abilities are crucial for effectively navigating the Disengagement stage.

Applying Nurse EI to Developmental Phenomenology

Most career models prior to Super focused on career choice as a “one- shot” decision. The goal of these models was mostly to assist people in matching their characteristics and interests with a corresponding career. This matching determined the choice of a person’s career which, short of making changes mid-career, was the biggest determinant of career trajectory. In contrast, Super described development of a life-long career as the consequence of a series of career choices. Within career stages, he also described “sub-cycles” in which an expert makes a career change that renders them a novice again. This is common among nurses, who have a wide range of options for specialty, role, and clinical contexts under the umbrella of professional nursing. An ICU nurse might leave the hos- pital to find satisfaction in home care or hospice. An expert clinical nurse could become a nurse educator or CNS. Access to these choices across life span offers nurses many options to reduce stress, adapt their career to support other elements of their life, increase job satisfaction, develop new interests, and experience continuous learning as they grow and change.

For nurses with extensive sub-cycle experience, the learning curve for each cycle may grow shorter. At the start of a sub-cycle, some aspects of the nurse’s practice revert to the Novice/Advanced Beginner stage (Table 10.1). For example, a clinical nurse takes an advanced practice role after

Chapter 10 Emotional Intelligence Across the Professional Lifespan 119

completing a master’s degree in business. Because other aspects of their practice, such as basic clinical, group, team, and organizational skills are usually already at a Proficient/Expert level, this expert clinical nurse may progress through a sub-cycle and progress quickly to expert leader. Nurses who thrive on change may have many such sub-cycles across their career and with experience, shorten the duration of sub-cycle achievement. Life- long learning, which represents sub-cycling on a micro level, may also be supported by EI ability.

TABLE 10.1 Example of Career Decisions Across One Nurse’s Professional Life Span

SAMPLE CAREER REFLECTIONS SUPER’S MODEL BENNER’S MODEL OF CLINICAL

COMPETENCY

“I always wanted to be a nurse, so I worked hard in high school to keep my grades up and I volunteered at a local nursing home.”

Stage: Growth (Imagination, interest)

Novice

“I got interested in cardiac nursing in nursing school.”

Stage: Growth (Development of interests) shifting to Exploration (Trying out roles, tentative choices)

Novice

“Cardiac care was my first job as a new graduate.”

Establishment (Entry- level skill building)

Novice/Advanced Beginner transition to Competent

“After a few years, I enjoyed being charge nurse.”

Shift back to Exploration (Change of roles)

May revert to Advanced Beginner

“I needed a challenge so I transferred to cardiac ICU.”

Change of setting and specialty focus (ICU); Exploration shifting rapidly to Establishment

Proficient

“I wanted to develop my leadership skills, so I was promoted to nurse manager.”

Exploration shifting rapidly to Establishment (Change of role and position within the organization)

Return to previous level for sub- cycling, then Proficient, for some nurses, Expert

(continued )

120 Emotional Intelligence in Nursing

TABLE 10.1 Example of Career Decisions Across One Nurse’s Professional Lifespan (Continued )

SAMPLE CAREER REFLECTIONS SUPER’S MODEL BENNER’S MODEL OF CLINICAL

COMPETENCY

“I started to burn out, so I moved to the cardiac rehab unit in a large business complex.”

Change of setting Novice; typically moves through following stages more quickly than the first time. May advance beyond previous cycle’s highest level of proficiency

“I had always loved teaching, and needed a day job while my kids were little, so I applied for a clinical instructor position at a community college.”

Change of role, change in specialty, change in setting

Novice; typically moves through following stages more quickly than the first time. May advance beyond previous cycle’s highest level of proficiency

“I really needed a total change. After my divorce, I was a flight nurse and went all over the world transporting patients.”

Change of role, change in specialty, change in setting

Novice; typically moves through following stages more quickly than the first time. May advance beyond previous cycle’s highest level of proficiency

“After retirement, I worked with the local Red Cross for medical response in the event of a disaster.”

Change in specialty, role, setting

Variable

DEVELOPING EMOTIONAL INTELLIGENCE ABILITY

SAMPLE EMOTIONAL INTELLIGENCE DEVELOPMENT EXERCISE #10: FRUSTRATION MANAGEMENT: LEAKING AND THRESHOLDS

In the management of a career across a lifespan, two of the greatest challenges are energy management and management of challenging emotions. The EI abilities of identification of emotions and under- standing emotions are especially helpful with both these challenges.

1. Energy management: Leaking: “Are you leaking?” When strong emotions are in play, particularly negative emotions, it is very easy to “leak” energy by pouring energy into these emotions. For example, on one very challenging clinical unit, whose fast pace

Chapter 10 Emotional Intelligence Across the Professional Lifespan 121

and constantly changing environment was particularly demand- ing, a common phrase was used, “Are you leaking?” This ques- tion was usually asked in a funny way, but the point was obvious. “I know you are feeling very (whatever the emotion is), but can you really afford to pour energy into it right now?”

2. Threshold management: Emotionally healthy and resilient peo- ple have high thresholds for negative emotions. It takes a lot of stimulus to get them angry, frustrated, anxious, or upset. But there are lots of things that can affect those thresholds. Fatigue is a good example. When someone is really tired, or overworked, or distracted, or in pain their thresholds drop. So it takes much less stimuli for them to get angry, frustrated, anxious, or upset. Identifying changes in thresholds can really help a person think about and manage difficult emotions. “I am going to ask you to bear with me today. I am exhausted and my thresholds are shot! If I get frustrated easily, please understand.” This is especially important in self-management of very strong emotions. Noticing when a strong emotion seems to be overtaking you, it is a good idea to check your thresholds.The strength of the emotion might have resulted from a drop in your usual threshold.

REFERENCES

Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.

Mayer, J. D., Caruso, D., & Salovey, P. (1999). Emotional intelligence meets traditional standards for an intelligence. Intelligence, 27, 267–298. https://doi .org/10.1016/S0160-2896(99)00016-1

Super, D. E., Savickas, M. L., & Super, C. M. (1996). The life-span, life-space approach to careers. In D. Brown, L. Brooks, & Associates (Eds.), Career choice and development (3rd ed., pp. 121–178). Jossey-Bass.