Leading nurses: emotional intelligence and leadership development effectiveness

This article evaluates the effectiveness of emotional intelligence and leadership development in nursing leadership. It discusses the importance of emotional intelligence in nursing, the impact of leadership development programs, and the need for training in emotional intelligence. The study examines the Leading Nurses Program and its objectives in improving the quality of care in nursing homes.

Leadership in Health Services
Leading nurses: emotional intelligence and leadership development effectiveness
Kerri Anne Crowne, Thomas M. Young, Beryl Goldman, Barbara Patterson, Anne M. Krouse, Jose Proenca,
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To cite this document:
Kerri Anne Crowne, Thomas M. Young, Beryl Goldman, Barbara Patterson, Anne M. Krouse, Jose Proenca, (2017) "Leading
nurses: emotional intelligence and leadership development effectiveness", Leadership in Health Services, Vol. 30 Issue: 3,
doi: 10.1108/LHS-12-2015-0055
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Leading nurses: emotional intelligence and leadership
development effectiveness
INTRODUCTION
Long-term care providers include adult day service centers, home health agencies,
hospices, nursing homes, and residential care communities which provide a variety of care
services for older individuals. Nursing home facilities comprise an important sector of the long-
term care field. In 2012 there were 15,700 nursing homes in the United States that served almost
1.4 million residents (Harris-Kojetin, Sengupta, Park-Lee and Valverde, 2013). These facilities
are staffed by a variety of employees, such as social workers and nursing assistants, but one
particular category of employees that play an important role in resident care is nurses. In nursing
homes, the Directors of Nursing (DONs) are mandated by federal law to be Registered Nurses
(RNs) (Fleming and Kayser-Jones, 2008) and RNs represent 11.7% of nursing home nursing
staff (Harris-Kojetin et al., 2013). The DONs have the ultimate responsibility for staffing the
nursing department in sufficient numbers to provide quality care. These tasks are critical and
many DONs report that they are ill prepared to meet them, even though some state that the
DONs hold the most crucial organizational positions in nursing homes when it comes to quality
of care (Fleming and Kayser-Jones, 2008; Rowles, 1995). One DON noted that nurses move
from strictly clinical positions to administrative positions with minimal management knowledge
or skill, which makes it difficult for them to be managers, let alone true leaders (Wunderlich,
Sloan and Davis, 1996),. Others also note that many nurses become formal leaders without
leadership training (Kerfoot, 2008; Swearingen, 2009). Therefore, it is widely acknowledge that
nursing managers are inadequately prepared for their roles (Newman, Patterson and Clark,
2015). Yet, while many skills are needed for nurses to be successful, scholars note that
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leadership development and training is critical for nurses (Dunne, Lunn, Kirwan, Matthews and
Condell, 2015), especially since leadership development is thought to be critical for optimal
success in managerial roles (Wong, Spence Laschinger, MacDonald‐Rencz, Burkoski,
Cummings, D'Amour, Grinspun, Gurnham, Huckstep, Leiter, Perkin, MacPhee, Matthews,
O'Brien‐Pallas, Ritchie, Ruffolo, Vincent, Wilk, Almost, Purdy, Daniels and Grau, 2013).
Moreover, nurse managers are thought to be highly influential to workplace cultures (Newman et
al., 2015) and scholars state that nurse leaders should look for development programs that focus
on both their emotional intelligence and the transformational leadership skills (O'Neill, 2013).
The Leading Nurses Program was designed and implemented to provide such development. This
paper will evaluate the effectiveness of some of the aspects of the program, which addresses a
recent call by scholars to evaluate specific leadership development programs (Dunne et al.,
2015).
The Leading Nurses Program Purpose
Nursing homes require strong leadership by DONs and other RN leaders in order to
improve the quality of care provided to residents in their facilities. The three-year Leading
Nurses project was developed and implemented to achieve Purpose P3 of the Nursing Education,
Practice, and Retention (NEPR) program. Leading Nurses provided leadership development for
DONs and other RN leaders working in nursing homes in the United States, specifically homes
in southeastern Pennsylvania, southern New Jersey, and Delaware. Content for the Leading
Nurses project was based on the results of a focus group conducted by the researchers in 2003 as
well as their follow-up demonstration project called Management Skill Development for Nursing
Leaders: Improving the Work Environment for Direct Care Workers.
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The goal of Leading Nurses was to improve the care of approximately 3,750 residents in
30 nursing homes through new skill sets and evidence-based protocols that were learned and
implemented by nurse leaders in these facilities. Other program objectives included:
1. To determine if there is a difference in emotional intelligence scores prior to an
educational intervention and at the end of 3 years for directors of nursing/nurse
managers
2. To determine the effectiveness of an emotional intelligence and leadership
educational intervention on leadership skills among directors of nursing/nurse
managers
3. To determine the perceptions of the long-term care work environment by staff
reporting to directors of nursing/nurse managers in the program and start and
completion of the program
4. To determine the impact of an emotional intelligence and leadership educational
intervention on nurse retention and core clinical indicators
This paper examines a portion of the data gathered during the three-year program.
Specifically, it provides an analysis of the data on the emotional intelligence and
transformational leadership that was conducted as part of the project; thus the first two purposes
above are most relevant to this article. Examination of objective 3 and 4 are beyond the scope of
this paper, since the goal here is to assess the effectiveness of the training program.
EMOTIONAL INTELLIGENCE DEVELOPMENT AND NURSING
Emotional Intelligence (EI) is an ability which focuses on the accurate perception and
expression of emotion; the understanding of emotional knowledge; the use of feelings to
facilitate thought; and to regulate emotions in oneself and others (Salovey, Mayer, Caruso,
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Lopes, Lopez and Snyder, 2003). It has also been defined as a non-cognitive capability that
influences one’s aptitude to cope in various situations (Bar-On, Tranel, Denburg and Bechara,
2003). It has been linked to multiple positive outcomes including performance (Carmeli and
Josman, 2006; Slaski and Cartwright, 2002; Wong and Law, 2002) and leadership (Akerjordet
and Severinsson, 2008; Alon and Higgins, 2005; Prati, Douglas, Ferris, Ammeter and Buckley,
2003).
The study of EI in nurses has been acknowledged as important (Akerjordet and
Severinsson, 2008; Eason, 2009). EI has been found to be related to positive empowerm
processes and positive organizational outcomes in nurse leadership (Akerjordet and
Severinsson, 2008). Some authors advocate using EI as a part of the criteria for hiring
nurses (Cadman and Brewer, 2001). Other areas that have been addressed include EI
conflict management styles (Morrison, 2008), retention (Feather, 2009; Wallis and
Kennedy, 2013), and teams (Wallis and Kennedy, 2013) in nursing. Furthermore, EI has
been found to be positively related to well-being and negatively related to job stress
(Karimi, Leggat, Donohue, Farrell and Couper, 2014) and correlated with better overall
health, greater work satisfaction, and decreased risk of job burnout (Powell, Mabry and
Mixer, 2015). Others have identified EI as one important factor in clinical leadership
(Leggat and Balding, 2013). Additionally, emotional intelligence of team members was
of the variables that had a positive impact on team dynamics, although the authors not
that the team’s effectiveness may have built the social competency (Wallis and Kennedy,
2013). One scholar stated that more research on EI and nurse leaders is needed becau
the shortage and high turnover of nurse leaders (Feather, 2009).
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Thus, the study of emotional intelligence in nurses is an important topic for
researchers and practitioners. It is critical to understand how EI can be improved becau
of the previously noted positive outcomes associated with it, and because it is likely a s
that would be helpful to directors of nurses in nursing homes and result in multiple
positive benefits.
Multiple authors have suggested educational training as a way to improve EI (Berman
and West, 2008; Gignac, Harmer, Jennings and Palmer, 2012; Laabs, 1999; Oginska-Bulik,
2005; Ornstein and Nelson, 2006; Pilkington, Hart and Bundy, 2012; Slaski and Cartwright,
2003; Zijlmans, Embregts, Gerits, Bosman and Derksen, 2011) and empirical data suggest that
training can effectively increase EI (Gignac et al., 2012; Herpertz, Schütz and Nezlek, 2016;
Khodayarifard, Cheshmenooshi, Nejad and Farahani, 2012; Slaski and Cartwright, 2003;
Zijlmans et al., 2011). One study found evidence to support increases in emotional identification
and emotion management abilities among individuals who were trained in emotional intelligence
(Nelis, Quoidbach, Mikolajczak and Hansenne, 2009). Another study of nurses found that EI
was advanced through a combination of training, experience, reflection, and reinforcement in
district nurses (Davies, Jenkins and Mabbett, 2010). However, at least one scholar believed that
EI training is not really of value (Clarke, 2006), and as EI development programs may vary
evaluating the effectiveness of an EI development program is important. Therefore this research
poses the question:
Research Question 1: Did the emotional intelligence development program have a
positive effect on emotional intelligence of nurses in nursing homes?
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TRANSFORMATIONAL LEADERSHIP AND NURSING
Many articles have focused on various topics related to leadership in the nursing sector
(Akerjordet and Severinsson, 2008; Aroian, 2000; Bennet, 2008; Laschinger, Wong and Grau,
2012; O'Neill, 2013; Sparks, 2012; Wallis and Kennedy, 2013; Wong and Laschinger, 2013;
Wong, Spence Laschinger and Cummings, 2010). One author noted that effective leadership in
health care is crucial because developing a pipeline of health care leaders is thought to be
essential, and because effective leadership is critical for optimizing cost, access, and quality
in health care(Stoller, 2013). Some recent articles have examined leadership training and
retention (Wallis and Kennedy, 2013), team retention strategies (Tourangeau, Cranley, Spence
Laschinger and Pachis, 2010), and generational differences on views of leadership (Sparks,
2012). Another area of focus in nursing seems to be authentic leadership, which is a positive,
relationship oriented leadership style (Laschinger et al., 2012; Wong and Laschinger, 2013;
Wong et al., 2010).
A critical area of research in nursing is the study of transformational leadership which is
one type of leadership style. It is characterized by the ability of the leader to understand the
organizational culture and realign it to a new vision (Bass and Avolio, 1993). Leaders who use
this style transform organizations by challenging themselves and their followers to achieve
success (O'Neill, 2013) and inspire and empower others in order to help them achieve great
outcomes (Ross, Fitzpatrick, Click, Krouse and Clavelle, 2014). They are visionary (O'Neill,
2013). Some view transformational leadership as encompassing authentic leadership,
innovation, and creativity, while also having the ability to build trust and relationships, as well
as expressing rational caring (Turkel, 2014). Nurse leaders need these skills due to the future
demands of the growing healthcare system in the United States based on the Affordable Care Act
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(O'Neill, 2013). Furthermore, these leadership skills are thought to be highly applicable to
nursing practice (Ross et al., 2014). Nurses need to become transformational leaders in order to
improve quality and safety in health care (Galuska, 2014). DONs in particular may need these
skills to perform the tasks assigned to them as leaders of nursing homes.
Additionally, educational training has been suggested as a way to improve leadership
skills (Dwyer, 2011; Stoller, 2013; Wallis and Kennedy, 2013), but limited research exists on the
effectiveness of leadership training in nursing practice. After conducting a review of the existing
literature on registered nurses as managers and leaders in long-term care facilities, one author
suggested that clinical leadership training is necessary for nurses (Dwyer, 2011). Wallis and
Kennedy (2013) found that leadership training was important for team retention, but noted more
research was needed. Some state that ongoing professional development that will enhance
nursing leadership skills will improve quality of care (Galuska, 2014). Others argue that this
type of leadership training is important, although some methods, such as traditional leadership
development and communication skills training, are ineffective in producing sustainable change
in behaviors (Dearborn, 2002). Since some have called for the importance of evaluating
leadership development programs (Dunne et al., 2015), the leadership training provided as part
of the Leading Nurses Program needs to be evaluated for effectiveness.
Research Question 2: Did the transformational leadership development program have a
positive effect on leadership skills of nurses in nursing homes?
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EMOTIONAL INTELLIGENCE AND TRANSFORMATIONAL LEADERSHIP OF
NURSES IN NURSING HOMES
Several authors have discussed a relationship between EI and transformational leadership
(Cavazotte, Moreno and Hickmann, 2012; Clarke, 2010; Connelly, Ruark and Waples, 2004;
Grunes, Gudmundsson and Irmer, 2014; Harms and Credé, 2010; Moss, Ritossa and Ngu, 2006;
O'Neill, 2013; Sosik and Megerian, 1999). But the evidence is mixed. Some researchers have
found significant relationships between EI and transformational leadership (Esfahani and Soflu,
2013; Foster and Roche, 2014; Khan, Khan, Saeed, Khan and Sanaullah, 2011; Sunindijo, 2012;
Wang and Huang, 2009). Foster and Roche (2014) found that even after controlling for
personality, EI was a significant predictor for transformational leadership.
However, some researchers found that emotional intelligence was not a useful predictor
for transformational leadership (Føllesdal and Hagtvet, 2013; Grunes et al., 2014), and others did
not find a relationship between EI and transformational leadership (Moss et al., 2006).
Cavazotte and colleagues (2012) found that the relationship between the variables was not
significant when controlling for other factors such as personality (Cavazotte et al., 2012); Kobe
and colleagues (2001) found that it was not a significant predictor when controlling for social
intelligence (Kobe, Reiter-Palmon and Rickers, 2001), meaning that each personality or social
intelligence was a stronger indicator of transformational leadership than EI. Other researchers
believed that common method bias and socially desirability responding (Harms and Credé, 2010)
may influence the relationship between EI and transformational leadership, thus the data
gathered on the relationship between EI and transformational leadership may be biased.
Furthermore, Moss and colleagues (2006), who specifically examined nurses’ emotional
intelligence and transformational leadership, found that those who reported high emotional
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intelligence did not have high transformational leadership (Moss et al., 2006). Therefore more
examination of the relationship between the variables is needed.
While there are many aspects of leadership such as leader’s style, behavior, and
subordinate relationships which have been frequently studied, few studies have been conduct on
leadership and EI in the context of nursing homes. Furthermore, scant research evaluates the
effectiveness of EI and leadership development in nurse leaders who work in nursing ho
facilities. One study examined leadership and EI in nurses at long-term care facilities
(Vesterinen, Isola and Paasivaara, 2009) and another study looked at the relationship among
observed leadership, job satisfaction, and turnover in long-term care facilities and did not find
that leadership practices impacted job satisfaction or turnover (Tourangeau et al., 2010). Other
scholars examined previous research on RNs as clinical leaders and managers in long-term care
facilities and found that nurses who work in these facilities have strong motivation to provide the
best outcomes for the elderly population they serve (Dwyer, 2011).
This study examined the relationship between EI and transformational leadership because
of the contradiction of previous research findings and because many suggested an association
between EI and various aspects of leadership (Akerjordet and Severinsson, 2008; Eason, 2009;
Feather, 2009; Horton-Deutsch and Sherwood, 2008; Kerfoot, 1996; Lucas, Laschinger and
Wong, 2008; Moss et al., 2006; O'Neill, 2013). Furthermore, it is important that these variables
be examined together in the setting of nursing homes to determine if they are related in this
context. By 2030, the number of Americans 65 and older is projected to reach 73 million, a
sharp increase from 40 million in 2010 (Hagerty, 2013), thus mandating more of a need for
nursing homes and nurse leaders to have strong EI and transformational leadership skills.
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Thus to have a better understanding of the relationship between EI and transformational
leadership in nurse directors, the following research question was examined:
Research Question 3: Will nurses with higher levels of emotional intelligence have higher
levels of transformational leadership?
LEADING NURSES DEVELOPMENT PROGRAM
The intent of the educational development program was to improve or enhance emotional
intelligence and transformational leadership. The program was held over three years. Year One
focused on skills assessment and development. The first nine daylong sessions explored the
leadership and management style of each DON and RN leader through emotional intelligence
assessment and training and leadership as well as change management skill development. The
last three sessions provided evidence-based protocols to improve the delivery of quality care.
During the first year, each facility received four, two-hour visits with a mentor who met with the
DON and RN leaders to discuss challenges and successes associated with leadership issues and
implementation of protocols.
Years Two and Three provided support and coaching through more intensive mentoring
and peer meetings. Each facility received six, two-hour visits with two of the visits conducted by
a member of the Leading Nurses leadership team plus eight, one-hour group conference calls. In
year three of the program, participants continued to receive the same level of mentoring received
in the previous year. They also formed a Peer Exchange Network to obtain ongoing information
and support from other Leading Nurses participants.
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Emotional Intelligence & Leadership Development
Sixty Directors of Nursing (DON) and Registered Nurse (RN) leaders assembled at the
start of the educational development program for introduction to and an overview of the entire
three-year training program. In the first year, 12 one-day classes were conducted. These classes
covered topics such as EI assessment and development, personal leadership development,
management development, and clinical protocols. Three of the classes specifically targeted EI
assessment and development and two covered personal leadership development. Each one-day
class was approximately 8 hours long.
During the initial meeting of the project participants, a brief presentation of the elements
of emotional intelligence was provided along with the rationale that improved emotional
intelligence could be the foundation for effective leadership development.
The classes for EI began approximately one month later. A full day was devoted to a
more detailed preparation for completing the EI assessment and actual self-administration of the
EI assessment. For about one hour, the faculty member described the five major areas assessed
by the EI assessment, provided samples of illustrative questions, and stressed the importance of
honest self-assessments versus inflated or desired ones. Immediately following this introductory
material, all participants completed the emotional intelligence assessment on-line. This was
followed by a de-briefing session. Although there were a few critical comments pertaining to
specific items, the general reaction was satisfaction with the experience as one that helped get
them “thinking about themselves.” Part of the afternoon was dedicated to understanding what the
EI assessment Development Report would look like.
At the second meeting, the faculty focused on the emotional intelligence assessment
Development Report. In the morning, a didactic review of the areas assessed by the emotional
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intelligence assessment was provided. This was followed by the faculty member’s display of the
results from his own Development Report and a discussion of steps he might take to improve his
emotional intelligence on three subscales on which he scored lowest. Participants were then
given hard copies of their individual Development Reports to read. A full group discussion
lasting 15-20 minutes was followed by small group “self-help” discussion groups. During the
“self-help” discussion the instructions were to brainstorm strategies for using the contents of
their EI assessment Development Reports and to develop strategies for improving EI on
subscales receiving lower scores. Each small group was instructed to prepare a summary for
reporting back to the full group, which followed immediately.
A third half-day of the educational program took place one month later. During this day
of the educational program, the trainees were assigned to one of four small discussion groups and
each group was given four scenarios of situations that posed challenges to the application of
emotional intelligence in a work situation. Each group was instructed to devote 30 minutes to
each scenario and prepare a summary report for the full group to discuss.
Approximately six weeks later a follow-up session was organized for those participants
who were still participating in the development program. Small groups were organized by the
trainer around those emotional intelligence assessment subscales of the composite scales
showing lower scores: Assertiveness and Independence, Problem-Solving, Self-Regard and
Optimism, and Self-Awareness and Interpersonal Relationships. The individuals in each group
were instructed to assess their progress over the past year in their respective subscales, identify
any barriers they had encountered, and describe strategies that they might employ to overcome
those barriers to further emotional intelligence development.
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Also, during the first year there were two one-day sessions conducted by a faculty
member on personal leadership development. The sessions focused on transformational
leadership development. Participants completed the Multifactor Leadership Questionnaire
(MLQ) and used their initial results from the MLQ to identify areas that they needed to work on.
The interactive activities in these workshops included group work discussing various aspects of
transformational leadership, sharing leadership challenges, and discussing alternatives for
addressing those challenges.
METHODOLOGY
Measures
The on-line version of the EQ-I (Bar-On, 2004), which is based on self-report, was used
to measure emotional intelligence. The EQ-i has been used in multiple studies in the past (Bar-
On et al., 2003; Dawda and Hart, 2000; Harper and Jones-Schenk, 2012; Ranjha and Shujja,
2010). This measure assesses emotional intelligence on 5 composite scales: Intrapersonal,
Interpersonal, Adaptability, Stress Management and General Mood (Bar-On et al., 2003).
Participants completed the assessment on-line and responses were on a Five-point Likert-type
scale (1 = Very seldom or Not True of Me, 2 = Seldom True of Me; 3 = Sometimes True of Me;
4 = Often True of Me; 5 = Very Often True of Me or True of Me). The measure showed
acceptable levels of reliability (Time 1: α = .949; Time 2: α = .947).
The Multifactor Leadership Questionnaire (MLQ) was used to measure transformational
leadership (Bass and Avolio, 2004). This self-report questionnaire had been used in previous
research (Connelly et al., 2004). Specifically, this study used the 20 items in the survey that
assessed transformational leadership. The subscales for this section of the MLQ included:
Idealized Influence (Attributed), Idealized Influence (Behavior), Inspirational Motivation,
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Intellectual Stimulation, and Individual Consideration (Bass and Avolio, 2004). Responses were
recorded on a Likert scale (blank = Unsure, 0 = Not at all, 1 = Once in a while, 2 = Sometimes, 3
= Fairly often, 4 = Frequently, if not always). This subset of the MLQ showed acceptable levels
of reliability (Time 1: α = .865; Time 2: α = .820).
Additionally, demographic data, which included age, gender, nursing education, years as
a nurse, and years as a supervisor, were collected by self-report at the start of the program. For
nursing education, participants were asked to indicate their highest level of nursing education
and selected from following options: Diploma in Nursing, Associates Degree in Nursing,
Bachelor’s Degree in Nursing, and Master Degree in Nursing. Participants were also asked to
indicate the number of years they had spent in nursing and the number of years they had been a
supervisor.
Sample
The study targeted registered nurses (RNs) in nursing homes. All private, non-profit and
government/county facilities in the five county Philadelphia area, South Jersey, and Delaware
were targeted and letters were sent to recruit. Individuals in leadership roles such as directors of
nursing (DON) or other types of nurse leaders, such as nurse managers, were targeted. Due to
the long-term nature of the project, nurses were interviewed to assess their commitment to
participate in the three-year educational program. From this process thirty sites were chosen and
55 nurses from these sites were selected. At the end of the three-year program 24 nurses had
completed the entire three-year training program. Attrition from the program was related to a
variety of factors including participants leaving their facility and/or moving to another position
such as administrator.
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After evaluating the data gathered from the participants that had completed the 3 year
program, usable date for both the EQ-i and the MLQ existed for only 20 participants. Mean
substitution was used to account for missing data for the 20 participants.
Descriptive statistics on the study variables are provided in Table 1.
-----------------------------------------
Insert Table 1 about Here
-----------------------------------------
Of the 20 participants, only one was male. Participants mean age was slightly over 50
years old with the range from 39 to 64. Participants indicated their highest level of nursing
education as diploma in nursing (15%), Associates degree (35%), Bachelors (45%), and Masters
(5%). In the sample, years as a nurse ranged from 4 to 38 years with the average number of
years in nursing just under 20 years. The range for years as a supervisor for the participants was
0 to 29 years with the average number of years as a supervisor just under 11 years.
RESULTS
To analyze the data, correlation tables were run first. Table 2 shows the correlations,
means, standard deviations, and alphas for the variables tested. Since the demographic variables
of gender and age did not correlate with any of the emotional intelligence or leadership variables,
they were removed from the subsequent analyses.
-----------------------------------------
Insert Table 2 about Here
-----------------------------------------
To answer Research Questions 1 and 2, paired t-tests were conducted to compare
emotional intelligence and leadership from Time 1 to Time 2. The analysis showed that the
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educational development program for emotional intelligence did have a significant impact on the
participants. The leadership development educational program did increase participants’ levels
of transformational leadership; however, the results were not significant. Table 3 shows the
results.
-----------------------------------------
Insert Table 3 about Here
-----------------------------------------
To answer Research Question 3 for the data provided at Time 1, the correlation table was
examined to see if a relationship existed between emotional intelligence in Time 1 and
transformational leadership in Time 1. The correlation was not significant. Therefore, the data
did not provide support for higher levels of emotional intelligence being related to higher levels
of transformational leadership.
To test Research Question 3 for the data provided at Time 2 after the program was
completed, the correlation table was reexamined. The results indicate that higher levels of
emotional intelligence in Time 2 were associated with higher levels of transformational
leadership (p < .05). Since the sample size was under 30, simple regression was the acceptable
form for further analysis (Hair, Black, Babin and Anderson, 2010). However, analyzing the
correlation table again, the highest correlation with transformational leadership in Time 2 was
transformational leadership in Time 1, not emotional intelligence in Time 2. Thus, even though
the correlation between emotional intelligence and transformational leadership in Time 2 was
significant, the data did not support higher levels of emotional intelligence leading to higher
levels of transformational leadership since it was recommended by Hair et al. (2010) that the
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strongest correlation be first selected to run a simple regression to minimize the sum of squares
errors of prediction.
To understand the data better, a post hoc analysis was done on the data. Examining the
correlation table again, nursing education was significantly related to transformational leadership
in Time 1 (p < .01) and Time 2 (p < .05). However, the strength of the relationship decreased
from Time 1 to Time 2.
DISCUSSION
The goal of the Leading Nurses Program was to improve the care of approximately 3,750
nursing home residents through the development of new skill sets and evidence-based protocols
learned and implemented by the nursing leaders in their facilities. Nurse leaders in nursing
homes are expected to provide better supervision and support to the certified nursing assistants
and other direct-care workers that in turn will result in improved care of nursing home residents.
The purpose of this paper was to present some of the findings from the Leading Nurses Program
and share its effectiveness.
This study contributes to the growing body of literature on emotional intelligence and
transformational leadership in nursing by specifically examining this population in nursing home
facilities, which is an underdeveloped, but important area of research. Considering the previously
noted aging population in the United States and the likely need for more nursing home facilities,
more nurses will need to become leaders. Organizations want to be aware of how to most
effectively prepare their directors of nursing in these facilities.
The findings that emotional intelligence was improved through the educational program
indicated the benefit of the long-term program. Moreover, it supported previous findings that EI
can be effectively developed (Gignac et al., 2012; Nelis et al., 2009; Slaski and Cartwright, 2003;
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Zijlmans et al., 2011). These findings also supported previous scholars who have suggested that
the competencies of emotional, social, and cognitive intelligence that predict effectiveness in
leadership can be developed (Boyatzis and Saatcioglu, 2008).
Considering the result that the leadership development component of the program did not
have a significant effect on the transformational leadership skills of the nurses who participated
in the program, further examination of the program content, design, and its effectiveness is
warranted. Since transformational leadership has been associated with positive organizational
outcomes such as leader effectiveness (Cavazotte et al., 2012) and group cohesiveness (Wang
and Huang, 2009), designing a program to effectively develop this style of leadership in nurse
leaders is important. Some scholars suggest that emotional intelligence might enhance the
capacity of managers to adapt their leadership style appropriately, but only in some contexts
(Moss et al., 2006). Therefore, it may be relevant to further examine how those with high
emotional intelligence appropriately adapt their leadership style and whether this style is a
transformational leadership style. Furthermore, scholars may want to further examine the
context of nurses who work in nursing homes to determine how to develop more effective
transformational leadership skills. Additionally, the amount of time devoted to the personal
leadership development in this program (two one-day classes) was less than the time devoted to
EI development (three one-day classes), which may have impacted the results.
Although the correlation analysis showed a positive and significant relationship between
emotional intelligence and leadership, which is consistent with some past research (Batool, 2013;
Benson, Martin, Ploeg and Wessel, 2012; Connelly et al., 2004), the sample size was under 30
and the relationship between emotional intelligence at Time 2 and transformational leadership in
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19
Time 2 was not the strongest relationship; thus it cannot be concluded that the results here
support the previously noted research.
A result from this study that should warrant more research was the finding that nursing
education had a significant positive relationship with transformational leadership in Time 1 and
Time 2. This is supported by past research that indicated that nursing education is the foundation
for transformational leadership development (Galuska, 2014). However, the relationship
decreased in strength at Time 2. This may indicate that the educational program provided by
Leading Nurses moderated the relationship between nursing education and transformational
leadership. In other words, that since there was a decrease in the strength of the relationship
between nursing education from Time 1 to Time 2, it is possible that the Leading Nurses
Program provided some supplemental educational development in leadership to those with lower
levels of education. Those with higher levels of education may have developed leadership skills
in their formal education.
This study also has important implications for practitioners. Organizations that want to
provide EI and leadership development may want to examine the program outlined here to guide
them in developing their own programs. The findings here, which suggest that a multi-year EI
development program was successful and the leadership development program warrants further
examination, are important information for organizations which are developing their own
programs.
Limitations & Future Research
There are several limitations to this study. First, the sample size was small, thus limiting
the analysis that could be conducted. Future studies should examine these variables with larger
samples. Second, the sample was not random. Due to the time commitment needed for the
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20
program, participants were self-selected or selected by agency administration. Researchers
should examine the relationships tested here in studies where there is random assignment. Third,
there was only one male, so future research should include a more proportional distribution by
gender. Fourth, this study focused on a very specific population, nurse leaders who were working
in nursing homes, so it is not generalizable to other populations. Fifth, other aspects of the
Leading Nurses Program were not analyzed as part of this research. Future researchers should
look at the impact of EI and leadership development as they relate to retention and core clinical
indicators.
Despite the noted limitations, this study adds value to the literature. With the aging of the
Baby Boomer generation and the growing need for quality nursing home care, developing a
better understanding of how to prepare nurse leaders in these facilities is critical. This study
provides evidence that long-term EI development can be effective in nurse leaders. In the
context of limited empirical data that exists on emotional intelligence, transformational
leadership and nurses, this study adds to the body of knowledge. Additionally, the longitudinal
study design was a strength. Future researchers should continue building on this area of research
so that organizations may better understand how to effectively develop their nurse leaders in
nursing homes, which in turn, should improve the quality of care received by their patients.
Acknowledgments
This research was funded by the Health Resources and Services Administration, Federal
Department of Health & Human Services to Kendal Outreach LLC and Widener University
(Grant Number: D11HP14609)
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21
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Table 1: Descriptive Statistics
N Minimum Maximum Mean Std. Deviation
Age 20 39 64 50.25 6.373
Gender 20 1 2 1.95 0.224
Nursing Education 20 1 4 2.4 0.821
Years as a
Supervisor 20 0 29 10.78 8.282
Years as a Nurse 20 4 38 19.5 10.288
Male = 1; Female = 2
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Table 2: Alpha, Means, Standard Deviations, and Correlations
Alpha Means
Standard
Deviations Age Gender
Nursing
Education
Years as a
Nurse
Years as a
Supervisor EI Time 1 EI Time 2
Transform-
ational
Leadership
T1
Transform-
ational
Leadership
T2
Age 50.25 6.373 1
Gender 1.95 .224 .009 1
Nursing
Education 2.40 .821 .080 -.459* 1
Years as a
Nurse 19.50 10.288 .679** .332 -.069 1
Years as a
Supervisor 10.78 8.282 .499* .221 -.137 .783** 1
EI Time 1 0.949 97.25 13.384 .324 -.171 .278 .265 .246 1
EI Time 2 0.947 110.70 10.458 .293 -.254 .401 .296 .271 .290 1
Transformation
al Leadership
T1
0.865 3.0242 .41641 -.115 -.410 .591** -.322 -.394 .029 .166 1
Transformation
al Leadership
T2
0.820 3.1425 .32698 -.319 -.401 .522* -.348 -.347 -.141 .490* .604** 1
**Correlation is significant at the 0.01 level (2-tailed).
*Correlation is significant at the 0.05 level (2-tailed).
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Table 3: Paired T-test for Emotional Intelligence and Leadership
Paired Differences
95% Confidence Interval
of the Difference
Mean
Std.
Deviation
Std. Error
Mean Lower Upper t df
Sig. (2-
tailed)
EI T2 - EI T1 13.450 14.398 3.220 6.711 20.189 4.178 19 .001**
Transformational Leadership
T2 - Transformational
Leadership T1
.11828 .34019 .07607 -.04093 .27750 1.555 19 .136
**Significant at the 0.01 level
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