A reflective framework to foster emotionally intelligent leadership in nursing
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A reflective framework to foster emotionally intelligent leadership
in nursing
BIRGIT HECKEMANN M S c , R N 1 , JOS M.G.A SCHOLS P h D , M D 2 and RUUD J.G. HALFENS P h D , F E A N S 3
1 PhD Student, CAPHRI – School for Public Health and Primary Care, 2 Professor of Old Age Medicine, Faculty of
Health, Medicine and Life Sciences, Department of Family Medicine and Department of Health Services Research,
CAPHRI- School for Public Health and Primary Care and 3Associate Professor, Faculty of Health, Medicine and
Life Sciences, Department of Health Care and Nursing Science, CAPHRI – School for Public Health and Primary
Care, Maastricht University, Maastricht, The Netherlands
Correspondence
Birgit Heckemann
CAPHRI
University of Maastricht
PO Box 616 MD
6200 Maastricht
the Netherlands
E-mail: b.heckemann
@maastrichtuniversity.nl
HECKEMANN B. , SCHOLS J.M.G.A. & HALFENS R.J.G. (2015) Journal of Nursing
Management 23, 744–753.
A reflective framework to foster emotionally intelligent leadership in
nursing
Aim To propose a reflective framework based on the perspective of emotional
intelligence (EI) in nurse leadership literature.
Background Emotional intelligence is a self-development construct aimed at
enhancing the management of feelings and interpersonal relationships, which has
become increasingly popular in nurse leadership. Reflection is an established
means to foster learning. Integrating those aspects of emotional intelligence
pertinent to nurse leadership into a reflective framework might support the
development of nurse leadership in a practical context.
Method A sample of 22 articles, retrieved via electronic databases (Ovid/Medline,
BNI, psycArticles, Zetoc and CINAHL) and published between January 1996 and
April 2009, was analysed in a qualitative descriptive content analysis.
Result Three dimensions that characterise emotional intelligence leadership in the
context of nursing – the nurse leader as a ‘socio-cultural architect’, as a
‘responsive carer’ and as a ‘strategic visionary’ – emerged from the analysis. To
enable practical application, these dimensions were contextualised into a reflective
framework.
Conclusion Emotional intelligence skills are regarded as essential for establishing
empowering work environments in nursing. A reflective framework might aid the
translation of emotional intelligence into a real-world context.
Implications for nursing practice The proposed framework may supplement
learning about emotional intelligence skills and aid the integration of emotional
intelligence in a clinical environment.
Keywords: emotional intelligence, reflective framework, reflective practice, resonant
leadership
Accepted for publication: 11 November 2013
Background
Emotional intelligence (EI), a self-development concept
that promises to enhance the management of feelings
and interpersonal relationships, has been proposed to
augment nurse leadership skills (Cummings et al.
2005, Lucas et al. 2008, Feather 2009). Yet little is
known about the attributes that define EI in a nursing
leadership context and how best to advance these in
individuals. Reflection has previously been suggested
744 DOI: 10.1111/jonm.12204
ª 2014 John Wiley & Sons Ltd
Journal of Nursing Management, 2015, 23, 744–753
in nursing
BIRGIT HECKEMANN M S c , R N 1 , JOS M.G.A SCHOLS P h D , M D 2 and RUUD J.G. HALFENS P h D , F E A N S 3
1 PhD Student, CAPHRI – School for Public Health and Primary Care, 2 Professor of Old Age Medicine, Faculty of
Health, Medicine and Life Sciences, Department of Family Medicine and Department of Health Services Research,
CAPHRI- School for Public Health and Primary Care and 3Associate Professor, Faculty of Health, Medicine and
Life Sciences, Department of Health Care and Nursing Science, CAPHRI – School for Public Health and Primary
Care, Maastricht University, Maastricht, The Netherlands
Correspondence
Birgit Heckemann
CAPHRI
University of Maastricht
PO Box 616 MD
6200 Maastricht
the Netherlands
E-mail: b.heckemann
@maastrichtuniversity.nl
HECKEMANN B. , SCHOLS J.M.G.A. & HALFENS R.J.G. (2015) Journal of Nursing
Management 23, 744–753.
A reflective framework to foster emotionally intelligent leadership in
nursing
Aim To propose a reflective framework based on the perspective of emotional
intelligence (EI) in nurse leadership literature.
Background Emotional intelligence is a self-development construct aimed at
enhancing the management of feelings and interpersonal relationships, which has
become increasingly popular in nurse leadership. Reflection is an established
means to foster learning. Integrating those aspects of emotional intelligence
pertinent to nurse leadership into a reflective framework might support the
development of nurse leadership in a practical context.
Method A sample of 22 articles, retrieved via electronic databases (Ovid/Medline,
BNI, psycArticles, Zetoc and CINAHL) and published between January 1996 and
April 2009, was analysed in a qualitative descriptive content analysis.
Result Three dimensions that characterise emotional intelligence leadership in the
context of nursing – the nurse leader as a ‘socio-cultural architect’, as a
‘responsive carer’ and as a ‘strategic visionary’ – emerged from the analysis. To
enable practical application, these dimensions were contextualised into a reflective
framework.
Conclusion Emotional intelligence skills are regarded as essential for establishing
empowering work environments in nursing. A reflective framework might aid the
translation of emotional intelligence into a real-world context.
Implications for nursing practice The proposed framework may supplement
learning about emotional intelligence skills and aid the integration of emotional
intelligence in a clinical environment.
Keywords: emotional intelligence, reflective framework, reflective practice, resonant
leadership
Accepted for publication: 11 November 2013
Background
Emotional intelligence (EI), a self-development concept
that promises to enhance the management of feelings
and interpersonal relationships, has been proposed to
augment nurse leadership skills (Cummings et al.
2005, Lucas et al. 2008, Feather 2009). Yet little is
known about the attributes that define EI in a nursing
leadership context and how best to advance these in
individuals. Reflection has previously been suggested
744 DOI: 10.1111/jonm.12204
ª 2014 John Wiley & Sons Ltd
Journal of Nursing Management, 2015, 23, 744–753
as a means to foster emotionally competent nurse lead-
ership (Horton-Deutsch & Sherwood 2008), however,
tools that facilitate EI-focused reflection are lacking.
This study aims to close this gap by proposing a reflec-
tive framework that integrates the attributes pertaining
to EI in nursing leadership.
Emotional intelligence
Emotional intelligence is a concept that has evolved
continually since it was first introduced into academia
by research psychologists Salovey and Mayer in the
early 1990s. They defined EI as:
‘the ability to perceive emotions, to access and
generate emotions so as to assist thought, to
understand emotions and emotional knowledge
and to reflectively regulate emotions so as to
promote emotional and intellectual growth’.
(Mayer & Salovey 1997 p. 5)
In 1996, EI was widely popularised outside
academic circles by Daniel Goleman with his book
Emotional Intelligence: Why It Can Matter More
Than IQ (Goleman 1996, Bulmer-Smith et al. 2009).
EI has since become a popular development tool and
has also found its way into health care (Freshman &
Rubino 2002).
Two major EI models, the ‘ability model’ and the
‘mixed models’, have been proposed. These differ in
scope, application and assessment methods (Schulte
et al. 2004).
Within the ability model, also called the ‘four-
branch model’, EI is described as a set of four distinct
skills and the extent to which these abilities are inte-
grated into an individual’s personality. The four abili-
ties are: ‘(1) to perceive emotion, (2) to use emotion
to facilitate thought, (3) to understand emotions, and
(4) to manage emotion’ (Mayer et al. 2004 p. 199).
According to this model, EI abilities range from a
basic level (recognition of emotions) to a more sophis-
ticated level (management of emotions) (Mayer &
Salovey 1997).
Within the ‘mixed models’, the concept of EI is
broadened. In addition to the ability to manage emo-
tions, mixed models include a number of personality
characteristics or traits such as empathy, persistence,
social skills and motivation among others, which do
not feature in Mayer and Salovey’s definition (Schulte
et al. 2004). The most popular model amongst these
is arguably the Goleman model of EI, which incorpo-
rates traits such as social awareness and relationship
management (Goleman 1996).
In the past, the concept of EI has been subject to
substantial criticism, mainly on the grounds that
claims of EI’s beneficial impact on work performance
and career progression were exaggerated and insuffi-
ciently substantiated (Bulmer-Smith et al. 2009).
However, current evidence suggests that EI is in fact
positively associated with job performance and well-
being (O’Boyle Jr et al. 2011). The proposed value of
EI is also increasingly being corroborated by neurosci-
entific evidence. The results of a recent study point to
a link between the self-rating of EI and the ability to
recognise and process social information (Kreifelts
et al. 2010).
Emotional intelligence and nurse leadership
Emotional intelligence with its emphasis on empower-
ment through the management of emotion appears to
be a complementary tool to support the current inter-
national drive towards fostering strong nurse leader-
ship in health care (ICN 2010). Skills such as
self-awareness, the capacity to establish purpose and
direction, and motivating and inspiring teams are
regarded as essential assets for achieving substantial
improvements in clinical practice (Warriner 2009) and
as a prerequisite for the creation of empowering work
environments (Davies et al. 2011). Yet little is known
about which particular attributes define EI leadership
in a nursing context (Akerjordet & Severinsson 2010).
In recent years, EI has been linked to a particular
leadership style, resonant leadership. The hallmark of
resonant leaders is the ability to work in tune with
their staff and colleagues. Resonant leaders use their
EI skills to manage their own emotions as well as
those of the people who work alongside them. They
create positive work environments and are aware of
organisational needs. They understand and success-
fully manage factors contributing to positive organisa-
tional outcomes. They are, in short, effective leaders
(Boyatzis & McKee 2005).
Resonant leadership has also reverberated in the
nursing literature. Current research concludes that res-
onant leadership in nursing not only contributes to
ameliorating patient safety and outcomes, but also
facilitates the creation of healthy work environments.
These enhance job satisfaction and the well-being of
nurses and thus contribute to recruitment and staff
retention (Cummings et al. 2010, Squires et al. 2010).
There is to date a shortage of capable leaders within
nursing, not least because leading in nursing is chal-
lenging (Hendricks et al. 2010, Enterkin et al. 2013).
Nurse leaders are expected to build and sustain
ª 2014 John Wiley & Sons Ltd
Journal of Nursing Management, 2015, 23, 744–753 745
Leading with emotional intelligence
ership (Horton-Deutsch & Sherwood 2008), however,
tools that facilitate EI-focused reflection are lacking.
This study aims to close this gap by proposing a reflec-
tive framework that integrates the attributes pertaining
to EI in nursing leadership.
Emotional intelligence
Emotional intelligence is a concept that has evolved
continually since it was first introduced into academia
by research psychologists Salovey and Mayer in the
early 1990s. They defined EI as:
‘the ability to perceive emotions, to access and
generate emotions so as to assist thought, to
understand emotions and emotional knowledge
and to reflectively regulate emotions so as to
promote emotional and intellectual growth’.
(Mayer & Salovey 1997 p. 5)
In 1996, EI was widely popularised outside
academic circles by Daniel Goleman with his book
Emotional Intelligence: Why It Can Matter More
Than IQ (Goleman 1996, Bulmer-Smith et al. 2009).
EI has since become a popular development tool and
has also found its way into health care (Freshman &
Rubino 2002).
Two major EI models, the ‘ability model’ and the
‘mixed models’, have been proposed. These differ in
scope, application and assessment methods (Schulte
et al. 2004).
Within the ability model, also called the ‘four-
branch model’, EI is described as a set of four distinct
skills and the extent to which these abilities are inte-
grated into an individual’s personality. The four abili-
ties are: ‘(1) to perceive emotion, (2) to use emotion
to facilitate thought, (3) to understand emotions, and
(4) to manage emotion’ (Mayer et al. 2004 p. 199).
According to this model, EI abilities range from a
basic level (recognition of emotions) to a more sophis-
ticated level (management of emotions) (Mayer &
Salovey 1997).
Within the ‘mixed models’, the concept of EI is
broadened. In addition to the ability to manage emo-
tions, mixed models include a number of personality
characteristics or traits such as empathy, persistence,
social skills and motivation among others, which do
not feature in Mayer and Salovey’s definition (Schulte
et al. 2004). The most popular model amongst these
is arguably the Goleman model of EI, which incorpo-
rates traits such as social awareness and relationship
management (Goleman 1996).
In the past, the concept of EI has been subject to
substantial criticism, mainly on the grounds that
claims of EI’s beneficial impact on work performance
and career progression were exaggerated and insuffi-
ciently substantiated (Bulmer-Smith et al. 2009).
However, current evidence suggests that EI is in fact
positively associated with job performance and well-
being (O’Boyle Jr et al. 2011). The proposed value of
EI is also increasingly being corroborated by neurosci-
entific evidence. The results of a recent study point to
a link between the self-rating of EI and the ability to
recognise and process social information (Kreifelts
et al. 2010).
Emotional intelligence and nurse leadership
Emotional intelligence with its emphasis on empower-
ment through the management of emotion appears to
be a complementary tool to support the current inter-
national drive towards fostering strong nurse leader-
ship in health care (ICN 2010). Skills such as
self-awareness, the capacity to establish purpose and
direction, and motivating and inspiring teams are
regarded as essential assets for achieving substantial
improvements in clinical practice (Warriner 2009) and
as a prerequisite for the creation of empowering work
environments (Davies et al. 2011). Yet little is known
about which particular attributes define EI leadership
in a nursing context (Akerjordet & Severinsson 2010).
In recent years, EI has been linked to a particular
leadership style, resonant leadership. The hallmark of
resonant leaders is the ability to work in tune with
their staff and colleagues. Resonant leaders use their
EI skills to manage their own emotions as well as
those of the people who work alongside them. They
create positive work environments and are aware of
organisational needs. They understand and success-
fully manage factors contributing to positive organisa-
tional outcomes. They are, in short, effective leaders
(Boyatzis & McKee 2005).
Resonant leadership has also reverberated in the
nursing literature. Current research concludes that res-
onant leadership in nursing not only contributes to
ameliorating patient safety and outcomes, but also
facilitates the creation of healthy work environments.
These enhance job satisfaction and the well-being of
nurses and thus contribute to recruitment and staff
retention (Cummings et al. 2010, Squires et al. 2010).
There is to date a shortage of capable leaders within
nursing, not least because leading in nursing is chal-
lenging (Hendricks et al. 2010, Enterkin et al. 2013).
Nurse leaders are expected to build and sustain
ª 2014 John Wiley & Sons Ltd
Journal of Nursing Management, 2015, 23, 744–753 745
Leading with emotional intelligence
productive teams. However, due to organisational
changes in health care, nurse leaders’ roles have
become increasingly managerial and removed from
front-line nursing. This may create a climate of dis-
trust between nursing staff and nurse leaders (Udod &
Care 2013). Leading with emotional intelligence is
regarded as a means to bridge this gap.
Reflection, emotional intelligence and nurse
leadership
Reflection has been proposed to foster emotionally
competent or resonant leadership (Horton-Deutsch &
Sherwood 2008). While its use as a means to promote
learning or empowerment is controversial (Fook et al.
2006), reflection has become an integral component of
nurse training and advanced professional development
(Mantzoukas & Jasper 2004).
Depending on the experience and need of the practi-
tioner, reflection may vary in depth (Rolfe et al. 2001
p. 24). Goodman (1984, cited by Jasper 2003 p. 7)
identified three levels of reflection. Reflection at the
first level is mainly descriptive. Second level reflection
connects principles and practice, i.e. the practitioner
assesses the implications and consequences of actions
and beliefs, as well as the underlying rationale for
practice. At the third and deepest level of reflection,
the practitioner is able to explore a complex situation
in depth by drawing on various theoretical, ethical,
political, personal, and professional perspectives (Jas-
per 2003). Horton-Deutsch and Sherwood (2008) con-
cisely describe the particular value of profound, third
level reflection:
‘Reflection is like the academic process of
describing, analysing, synthesising and evaluat-
ing with the addition of self-awareness. Reflec-
tion includes the emotions and feelings that are
an integral part of practice but are often
ignored’.
(Horton-Deutsch & Sherwood 2008 p. 949).
Third-level reflection can therefore help nurse
leaders to systematically examine experiences and situ-
ations from various angles to increase self awareness
and to promote learning from experience (Horton-
Deutsch & Sherwood 2008). A framework that
enables third-level reflection has been described by
Rolfe et al. (2001 p. 34–36). Their framework takes
the practitioner through a three-step cyclical process
of analysis: from a descriptive stage over a theory
building stage to an action oriented stage (Rolfe et al.
2001 p. 34–36).
The study
Aim
The aim of this study was twofold. First, to explore
the meaning of EI as pertaining to nurse leadership,
and second, to enable the practical application of the
findings by contextualising them into a reflective
framework.
Design
To explore the meaning of EI in nursing, a qualitative
descriptive study of literature pertaining to EI and
nurse leadership was conducted. The analysis followed
Krippendorff’s (2004 p. 86) model of content analysis
and was conducted from an epistemological stance of
moderate constructivism (Hoijer 2008).
Sample
Publications were selected according to the following
criteria.
Inclusion criteria: Articles, original research papers,
editorials or literature review studies, written in Eng-
lish, published between January 1996 and April 2009
and exploring explicitly and exclusively ‘EI’ in relation
to nurse leadership were included into the study.
Exclusion criteria: Articles addressing similar con-
structs such as ‘social-emotional competence’, ‘psycho-
social functioning’ or ‘emotional language skills’ etc.
were excluded, because one of the aims of this study
was to define the construct called ‘EI’.
Electronic databases (Ovid/Medline, BNI, Zetoc,
CINAHL and PsycArticles) were searched using the
following search string: ‘EI’ AND nurs* AND leader*
(‘*’ indicates truncation). This initial search yielded
406 references (see Figure 1). Titles were screened for
Electronic databases:
ovid/MEDLINE, BNI, Zetoc
CINAHL, PsycArticles
Total: n = 406
Articles retrieved
from hand search
n = 2
n = 73
n = 55
n = 20
Figure 1
Diagram of sampling process.
ª 2014 John Wiley & Sons Ltd
746 Journal of Nursing Management, 2015, 23, 744–753
B. Heckemann et al.
changes in health care, nurse leaders’ roles have
become increasingly managerial and removed from
front-line nursing. This may create a climate of dis-
trust between nursing staff and nurse leaders (Udod &
Care 2013). Leading with emotional intelligence is
regarded as a means to bridge this gap.
Reflection, emotional intelligence and nurse
leadership
Reflection has been proposed to foster emotionally
competent or resonant leadership (Horton-Deutsch &
Sherwood 2008). While its use as a means to promote
learning or empowerment is controversial (Fook et al.
2006), reflection has become an integral component of
nurse training and advanced professional development
(Mantzoukas & Jasper 2004).
Depending on the experience and need of the practi-
tioner, reflection may vary in depth (Rolfe et al. 2001
p. 24). Goodman (1984, cited by Jasper 2003 p. 7)
identified three levels of reflection. Reflection at the
first level is mainly descriptive. Second level reflection
connects principles and practice, i.e. the practitioner
assesses the implications and consequences of actions
and beliefs, as well as the underlying rationale for
practice. At the third and deepest level of reflection,
the practitioner is able to explore a complex situation
in depth by drawing on various theoretical, ethical,
political, personal, and professional perspectives (Jas-
per 2003). Horton-Deutsch and Sherwood (2008) con-
cisely describe the particular value of profound, third
level reflection:
‘Reflection is like the academic process of
describing, analysing, synthesising and evaluat-
ing with the addition of self-awareness. Reflec-
tion includes the emotions and feelings that are
an integral part of practice but are often
ignored’.
(Horton-Deutsch & Sherwood 2008 p. 949).
Third-level reflection can therefore help nurse
leaders to systematically examine experiences and situ-
ations from various angles to increase self awareness
and to promote learning from experience (Horton-
Deutsch & Sherwood 2008). A framework that
enables third-level reflection has been described by
Rolfe et al. (2001 p. 34–36). Their framework takes
the practitioner through a three-step cyclical process
of analysis: from a descriptive stage over a theory
building stage to an action oriented stage (Rolfe et al.
2001 p. 34–36).
The study
Aim
The aim of this study was twofold. First, to explore
the meaning of EI as pertaining to nurse leadership,
and second, to enable the practical application of the
findings by contextualising them into a reflective
framework.
Design
To explore the meaning of EI in nursing, a qualitative
descriptive study of literature pertaining to EI and
nurse leadership was conducted. The analysis followed
Krippendorff’s (2004 p. 86) model of content analysis
and was conducted from an epistemological stance of
moderate constructivism (Hoijer 2008).
Sample
Publications were selected according to the following
criteria.
Inclusion criteria: Articles, original research papers,
editorials or literature review studies, written in Eng-
lish, published between January 1996 and April 2009
and exploring explicitly and exclusively ‘EI’ in relation
to nurse leadership were included into the study.
Exclusion criteria: Articles addressing similar con-
structs such as ‘social-emotional competence’, ‘psycho-
social functioning’ or ‘emotional language skills’ etc.
were excluded, because one of the aims of this study
was to define the construct called ‘EI’.
Electronic databases (Ovid/Medline, BNI, Zetoc,
CINAHL and PsycArticles) were searched using the
following search string: ‘EI’ AND nurs* AND leader*
(‘*’ indicates truncation). This initial search yielded
406 references (see Figure 1). Titles were screened for
Electronic databases:
ovid/MEDLINE, BNI, Zetoc
CINAHL, PsycArticles
Total: n = 406
Articles retrieved
from hand search
n = 2
n = 73
n = 55
n = 20
Figure 1
Diagram of sampling process.
ª 2014 John Wiley & Sons Ltd
746 Journal of Nursing Management, 2015, 23, 744–753
B. Heckemann et al.
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