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Emotional Intelligence (EI) and Nursing Leadership Styles Among Nurse Managers

Brenda Tyczkowski, DNP, RN; Christine Vandenhouten, PhD, RN, APHN-BC; Janet Reilly, DNP, APRN-BC; Gaurav Bansal, PhD; Sylvia M. Kubsch, PhD, RN; Raelynn Jakkola, BSN

Less than 12.5% of nurses aspire to leadership roles, noting lack of support and stress as major factors in their decision not to pursue this area of practice. Psychological resiliency, described as the ability to properly adapt to stress and adversity, is key to successful nurse managers. Emotional intelligence (EI) is a related concept to resiliency and is another noteworthy predictor of leadership and management success. This study was undertaken to determine the level of and relationship between EI and leadership style of nurse managers employed in Wisconsin and Illinois facilities. A descriptive, exploratory study design was utilized, with a convenience sample of nurse managers working in 6 large Midwestern health systems. Nurse managers were invited to participate in the study by their employer, completing the online consent form and the demographic, Multifactor Leadership Questionnaire (MLQ) Form 5X and the Emotional Quotient Inventory (EQ-i 2.0) surveys. Statistically significant positive relationships were noted between EI and transformational leadership and the outcomes of leadership (extra effort, effectiveness, and satisfaction). No statistically significant relationships were noted between EI and transactional or laissez-faire leadership styles. Key words: emotional intelligence, leadership style, nurse managers, resiliency, transactional leadership, transformational leadership

T HE SCOPE of responsibility and the depth of knowledge, skills, and attitudes needed to be an effective nurse manager (NM) continue to expand. This expanding role leads to stress among NMs. Emotional intelligence (EI) is a useful tool to enhance psychologi- cal resiliency to this stress. High levels of EI can enhance transformational leadership style

Author Affiliations: University of Wisconsin Green Bay (Drs Tyczkowski, Vandenhouten, Reilly, Bansal, and Kubsch); and St. Vincent Hospital, Hospital Sisters Health System, Green Bay, Wisconsin (Ms Jakkola).

Funding obtained through University of Wisconsin Green Bay dean and graduate studies grant. The authors declare no conflict of interest.

Correspondence: Brenda Tyczkowski, DNP, RN, Uni- versity of Wisconsin Green Bay, 2420 Nicolet Dr, Green Bay, WI 54311 ([email protected]).

DOI: 10.1097/NAQ.0000000000000094

required to create and maintain a positive working environment.1 By understanding the relationship between EI and NMs’ leadership style, efforts may be taken to enhance EI be- haviors and subsequently, resiliency.

The literature was reviewed to see what has been written on EI and leadership styles. Nurses are involved in countless interactions each day requiring the display of leader- ship behavior, including EI.2 Emotional intelli- gence was correlated with positive processes in health care environments and positive in- stitutional outcomes.3 Emotional intelligence scores of NMs were positively correlated with patient outcomes, MD and patient satisfac- tion, reduced staff turnover, and increased staff resilience.4,5

Nurses who consistently dealt with emo- tional interpersonal relationships reported higher than average levels of EI using the

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Bar-on EQ-i survey tool to test EI. This rein- forces the importance of having a high level of EI to help manage interpersonal relationships as part of nursing leadership. Authors of the study recommended incorporating EI training in nursing education. Improved training in EI will lead to better interpersonal communica- tion and better patient outcomes.6 Emotional intelligence is a skill that can be learned by means of counseling, training, and keeping a reflective emotional journal.7

Emotional intelligence requires self- awareness and can be further enhanced through practice and feedback. The cor- relation between EI and successful nurse leaders is well documented.5 According to these authors, EI refers to the ability to discriminate and monitor emotions and use the evidence to guide action and thought. The relationship between EI and effective leadership has been validated by others.1,8-10

The most effective leaders were those with high EI.11 A study conducted in Boston with more than 20 000 executives found that EI was twice as important as technical skills and cognitive abilities in determining leadership ability.11 High-level EI leaders bring out the best in members of the organization, drive emotions in a positive manner, connect with others at an emotional level, and make work more meaningful.11 It is important for leaders to recognize their own emotions and to be able to express those emotions to others.12 In doing so, the leader uses his or her positive emotions to motivate others and enable the vision of the organization to be enacted through job performance.

In a meta-analysis, leaders with high levels of EI were shown to demonstrate transforma- tional leadership styles. Subordinates consis- tently rated transformational leaders as more effective than laissez-faire and transactional leadership styles.13

There is considerable agreement that high levels of EI are a necessary component of transformational leadership.14-16 Transforma- tional leaders develop constructive and posi- tive relationships with followers and respond to their emotional needs.17 Significant re-

lationships were found between subscales of EI and components of transformational leadership.14,15 Emotional intelligence is as- sociated with 3 attributes of transformational leadership (using the Multifactor Leadership Questionnaire [MLQ] survey): idealized influ- ence, individualized consideration, and inspi- rational motivation.1 These authors also found that high levels of EI (using the Bar-on EQ-i) can enhance transformational leadership style required to create and maintain a positive working environment.

One study found a strong correlation between transformational factors and leader effectiveness, satisfaction, and extra effort.18

Subordinates were more satisfied with transformational leaders and perceived them as more effective than laissez-faire leaders. Another study examined the relationship between leadership style and extra effort, perceived leadership effectiveness, and satis- faction with the leader.19 It found a stronger relationship between transformational and outcomes factors than between these factors and transactional and laissez-faire styles. Another study found that charismatic leaders were similar to transformational leaders in that they did not influence followers on the basis of authority.20 Rather, they were highly self-confident and had a set of behaviors that followers imitated. Transactional leaders used a negotiation process, in which followers exchanged efforts for rewards.20 Several studies noted strong relationships between EI and transformational leadership.21-23

Resiliency, EI, and leadership style have been identified as traits in successful NMs.2,14,18,24 Resiliency includes constructs similar to EI: energy, passion, the ability to bounce back from hardships, drive, “tanks seems full”, grounded, adaptable, and a healthy work/life balance.24(p138) To cope, leaders need to be resilient and agile, able to accept complex change, be emotionally intel- ligent, and able to help others move forward and achieve success.25 Organizations need to foster EI and resiliency into their culture and leaders. Resilient leaders are positive, flexible, focused, and are able to deal with reality and

https://meaningful.11

https://ability.11

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improvise. Furthermore, they are self-aware, able to manage themselves, are aware of oth- ers, and can manage relationships. Resilient leaders demonstrate EI.25

METHODS

A descriptive exploratory study was con- ducted to explore the level of and relation- ship between EI and leadership styles of NMs employed in Wisconsin and Illinois. A con- venience sample of NMs working in 6 large Midwestern health systems was used for this study.

Emotional intelligence is operationally de- fined in this study as having “abilities such as being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the ability to think; to empathize and to hope.”11(p34) Re- siliency is defined through similar constructs, including perseverance (persistence), equa- nimity (self-control), and positive psychologi- cal capital (hope).26 Emotional management is recognized as a protective factor in resiliency along with the ability to bounce back and move on in life after adversity is present.27

DATA COLLECTION

Demographic survey questions were derived from the literature review and with input from participating health care institu- tions. The MLQ Form 5X was used to measure the leadership style of NMs.18 This survey instrument includes 45 items designed to mea- sure the frequency of leadership behaviors using a 5-point Likert-type scale. Leadership styles include transformational, transactional, and passive/avoidant.18 Transformational leadership consists of 5 subscales (idealized attributes, idealized behaviors, inspirational motivation, intellectual stimulation, and individualized consideration). Transactional leadership style includes 2 subscales, namely, contingent reward and management by ex- ception (active). Passive/avoidant leadership style is made up of 2 subscales including

management by exception (passive) and laissez-faire. The MLQ Form 5X also measures 3 outcomes of leadership—extra effort, effec- tiveness, and satisfaction. The MLQ Form 5X has demonstrated reliability and validity.18

A gold standard measurement of resiliency has not yet been identified26; therefore, the related concept of EI was explored, using the EQ-i 2.0 survey tool to measure the EI of NMs. The EQ-i 2.0 tool uses a 5-point Likert-type scale to measure emotional intelligence and coping ability as components of personality and disposition on the basis of responses to 133 survey questions.28 Results provided in- clude a total EI score and 5 composite scale scores (self-perception, self-expression, inter- personal, decision making, and stress manage- ment) based on the Bar-on Model of Emo- tional intelligence.28 The EQ-i 2.0 has been used worldwide and has acceptable reliability and validity.

While the possible pool of NMs was not de- termined, a total of 142 NMs completed the demographic items, 128 completed the MLQ Form 5X, and 110 NMs completed the EQ-i 2.0 instruments. Matched responses to the de- mographic, MLQ Form 5X and EQ-i 2.0 items were available for 77 NMs.

FINDINGS

Data were analyzed using SPSS, Version 21 (IBM Corp., Armonk, NY) and Partial Least Square (PLS) software (SmartPLS 3, Hamburg, Germany).28 Descriptive statistics were calcu- lated for demographic variables and mean to- tal MLQ-5X scale and subscale scores. EQ-i 2.0 scores were reported collated and analyzed by Multi-Health Systems Inc.29

As presented in Table 1, participants in this study were primarily female (92%), white (97%), and 61 years of age or older (35%). The highest level of education reported by participants was BSN (56%), with the major- ity of subjects reporting less than 5 years’ ex- perience as a manager (34%). When asked about previous training in EI, 62% reported having no previous EI training. This points out the opportunity to provide training on the

https://Germany).28

https://intelligence.28

https://questions.28

https://validity.18

https://passive/avoidant.18

https://present.27

https://hope).26

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Table 1. Demographic Characteristics of the Sample (n = 142, Respondents Who Completed Entire Demographics Section of Survey)

Variable (n = Respondents for Question) n (%)

Sex (n = 146) Male 13 (9) Female 133 (91)

Race/ethnicity (n = 146) White/Caucasian 138 (95) Asian 3 (2) Black/African American 2 (1) Hispanic/Latino 2 (1) Pacific Islander 1 (1)

Level of education (n = 141) BSN 78 (55) MSN 21 (15) MS-other 20 (14) ADN 14 (10) Other 8 (6)

Experience as NM (n = 146) <5 y 48 (33) 5-10 y 40 (27) 11-15 y 23 (16) 16-20 y 13 (9) 20+ y 22 (15)

Time spent on NM duties (n = 141) >75% 105 (74) 51%-75% 22 (16) <50% 14 (10)

Employment setting (n = 146) Inpatient 64 (45) Outpatient 30 (20) Other 52 (35)

Title (n = 146) Nurse manager 63 (43) Director 12 (8) Other 71 (49)

Previous training in EI (n = 146) Yes 57 (39) No 89 (61)

Previous training in leadership styles (n = 146)

Yes 114 (78) No 32 (22)

Appropriate training to deal with conflict (n = 146)

Yes 116 (79) No 30 (21)

(continues)

Table 1. Demographic Characteristics of the Sample (n = 142, Respondents Who Completed Entire Demographics Section of Survey) (Continued)

Variable (n = Respondents for Question) n (%)

Confidence in resolving conflict on the unit (1- to 10-point scale, 10 = high confidence) (n = 146)

Mean 7.9 Standard deviation 1.5

Level of interdisciplinary teamwork on the unit (1- to 10-point scale, 10 = high level of collaboration (n = 146)

Mean 7.8 SD 1.7

Abbreviation: NM, nurse manager.

concepts of EI and leadership styles to a young, up-and-coming generation of NM.

Participants who completed the MLQ Form 5X described their leadership on each of 45 items using a Likert-type scale, with 0 = not at all to 4 = frequently, if not always. Scale and subscales of the MLQ Form 5X includ- ing range of scores, measures of central ten- dency, and reliability results were calculated using SPSS and are reported in Table 2. Re- sults indicate the majority of NMs’ leadership style aligned with that of transformational, fol- lowed by transactional and passive avoidant. Participants indicated higher satisfaction with leadership behavior (3.35), followed by effec- tiveness (3.26), and finally their ability to mo- tivate (2.97).

Results from participants who completed the EQ-I 2.0 survey provide total EI scores and five composite scale scores (see Table 3). The mean total EQ score for participants was 107.76. As noted in Figure 1, 8.2% (n = 9) of the participants scored below average for the total EQ, 42.7% had an average EQ score (n = 47), while 49.1% (n = 54) showed a higher than average EQ score.

The 5-component scale scores included on the EQ-i 2.0 tool are stress management, de- cision making, interpersonal, self-expression,

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Table 2. Multifactorial Leadership Questionnaire (MLQ Form 5X) Results (n = 128)

Scale and Subscale Item #’s Range Mean SD Cronbach α

Total MLQ 5X 1-45 0.848 Transformative 2.25-4.0 3.28 0.385 0.853

Idealized Attributes 10,18,21,25 1.75-4.0 3.04 0.532 0.448 Idealized Behaviors 6,14,23,34 1.25-4.0 3.25 0.545 0.569 Inspirational Motivation 9,13,26,36 2.0-4.0 3.38 0.499 0.742 Intellectual Stimulation 2,8,30,32 1.5-4.0 3.29 0.510 0.663 Individual Consideration 15,19,29,31 2.25-4.0 3.44 0.452 0.645

Transactional 1.25-4.0 2.36 0.493 0.560 Contingent Reward 1,11,16,35 2.0-4.0 3.22 0.509 0.416 Management by Exception-Active 4,22,24,27 0.0-4.0 1.54 0.744 0.658

Passive Avoidant 0.0-4.0 .65 0.497 0.735 Management by Exception-Passive 3,12,17,20 0.0-4.0 .76 0.604 0.702 Laissez-Faire 5,7,28,33 0.0-4.0 .53 0.536 0.507

Outcomes of Leadership 1.86-4.0 3.19 0.468 0.821 Extra Effort 39,42,44 1.0-4.0 2.97 0.627 Effectiveness 37,40,43,45 2.0-4.0 3.26 0.488 0.848 Satisfaction 38,41 1.0-4.0 3.35 0.543 0.853

and self-perception. A sixth area was ex- plored, on the basis of data analysis, entitled “happiness.” High EQ-i 2.0 scores (above 100) indicate emotionally intelligent people, while lower scores indicate a need to improve EI in specific areas (Table 3).

Figure 2 describes the relationship be- tween EI and NM’s leadership style. Results demonstrate that EI explains 18% of variance in transactional leadership style, 20% of the variance in passive/avoidant leadership style, 41% of the variance in outcomes of leader- ship, and 44% of the variance (R2) in trans- formational leadership style. In addition, self-

Table 3. EQ-i 2.0 Total and Composite Scale (Standard) Scores

Scale and Subscale Range Mean SD

Total EQ-i 2.0 74-132 107.76 11.29 Stress Management 64-130 107.18 11.59 Decision Making 76-131 107.4 11.18 Interpersonal 81-125 108.02 10.19 Self-Expression 72-132 105.98 12.18 Self-Perception 67-126 104.83 11.80 Happiness 40-124 107.64 15.09

expression is found to be positively related to transformational leadership style and out- comes of leadership (EES; it is the “Outcomes of Leadership” scale, which comprises “ex- tra effort,” “effectiveness,” and “satisfaction”). Stress management skills are negatively asso- ciated with passive avoidant leadership styles (P < .05) and positively associated with out- comes of leadership. Finally, while the rela- tionship between self-perception and transac- tional leadership style was not significant (P < .10), it was positively associated. In this study, there was no significant association between EI areas of decision making, interpersonal, or happiness and leadership styles.

DISCUSSION

The majority of NMs in this study had high EI scores and the predominant leadership style identified by respondents in this study was transformational, followed closely by average EI scores and outcomes of leadership (extra effort, effectiveness, and satisfac- tion). Sixty-two percent of the respondents acknowledged previous EI training and educa- tion, while over three-fourths of respondents

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Emotional Intelligence and Nursing Leadership Styles 177

Below Average Average Above Average

Figure 1. Mean total (standard) EQ-i 2.0 score of NMs. Note: Below average scores = <90; average scores

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= 90 to 109; above average = >109.

reported having previous leadership training, which may have affected the results of this study. The literature noted many nursing studies indicating that EI and transformational leadership were teachable skills.14 Offering course content, continuing education or professional development opportunities to develop EI, and transformational leadership could have significant implications for nursing

educational institutions, health care systems, and the quality of management skills in their nursing students and current and future NMs.

In this study, a significant positive rela- tionship between EI factors and transfor- mational leadership style was noted. These results are consistent with those of other stud- ies that found an association between EI and transformational leadership suggested in the

Figure 2. Relationship between emotional intelligence and leadership styles.

https://skills.14

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literature.10,14,15 It can be proposed that lead- ership style and EI in NMs impact health care systems, in their parts and as a whole, since EI and leadership style are known to influence not only individual NM success but also the overall nursing unit or environment.10,15,30

While there is some evidence that self- perception is associated with transactional leadership styles, the relationship is weak. Fu- ture research is needed to explore the rela- tionship. The lowest mean leadership style of NM respondents in this survey was passive- avoidant. This leadership style provided re- spondents the least ability to manage stress, therefore reducing their resiliency. Previous literature has supported the hypothesized relationship between low EI and burnout.5

The literature notes the need for EI and the ability to rebound from stress in effective leadership.31 To create resilient and effective NMs, health care systems must assist NMs to build EI skills and transformational leadership qualities/skills including stress management, decision-making and happiness.

Almost one-third of respondents in this sur- vey were 61 years of age or older. This speaks to the aging nursing workforce and its aging NMs while adding urgency to prepare future NMs who will be knowledgeable in EI.32 More than half of the NM participants were pre- pared at the BSN level, confirming the sugges- tion that EI education should be included in the bachelor’s-level nursing curriculum2 and encouraging the Institute of Medicine report Initiative on the Future of Nursing recom- mendation 7 to “prepare and enable nurses to lead change and advance health.”33

Some factors limited the results of this study. The demographic and MLQ 5X ques- tions were combined into 1 instrument. The EQ-i 2.0 survey was hosted on a separate, proprietary Web site, which added complex- ity for participants. Participants in this study needed to enter the name of their institution on both the combined demographic and MLQ 5X instruments and on the EQ-i 2.0 instru- ment to allow manual, de-identified match- ing of data. Some participants did not iden- tify their institution on both surveys, reducing

the number of surveys available for compar- ison. The result was a loss of 33 unmatched response sets.

An additional factor related to the small sample size available for data analysis could be the inherent level of respondent survey fa- tigue or lack of time at work to complete the 3 surveys because of the number of instru- ment questions. While both the EQ-i 2.0 and the MLQ 5X had psychometric data indicat- ing reliability and validity, the data were self- reported and from a sample with the majority being white, female NMs. Additional studies with 360◦ approaches to assess NM leader- ship styles, resiliency, and EI in larger, more diverse samples of NMs are needed.

IMPLICATIONS

So what do these results mean to (nurse) managers and administrators? The results of this study are important to health care systems as they experience an increased need to educate, recruit, and retain top-performing

10,15,30 nursing leadership and managers. As a related factor to resiliency, EI is not static and can be taught and enhanced.14 Emotional intelligence and predominant leadership style assessment could be considered by health systems in pre-employment screening as a way to recruit the strongest applicants to nursing management and administration. These assessments could also be included in performance reviews for existing NM em- ployees or in succession planning to groom future NMs. The ideal candidate for leader- ship development programs are nurses who are in the early stages of their career, who hold a BSN or higher.34 In response to health care reform and improvement, the Institute for Healthcare Improvement, in collaboration with the Robert Wood Johnson Foundation, created a how-to-guide for health systems to create NMs who will lead innovation and improvement.35 This guide includes a 4- pronged approach to improve NMs’ ability to support transformational change that includes talent management, formalized nursing lead- ership development programs, development

https://improvement.35

https://higher.34

https://enhanced.14

https://leadership.31

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of leaders’ EI, and effective succession for the development of strong and resilient planning. The concepts and results found in nurse leaders in tomorrow’s health care this study most certainly support such efforts systems.

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