If you wanted to invent a profession that combined extraordinarily high cognitive, physical, and emotional demands, it would be “nursing.” Nurses are intelligent, possess sophisticated technical skills, and are educated to meet the physical and psychosocial needs of patients and families.

But IQ and technical competence, while important, may overshadow another essential quality for star performances, emotional intelligence, the knowledge of how emotions function within both oneself and others.¹ This module will explain what emotional intelligence is, how it can be strengthened, and why working with EI is particularly relevant for nursing.

Consider the actions of the following nurses:

• Anne has been an operating room nurse for about three years. Here’s an e-mail she just wrote to a close friend: “What a day! Got my evaluation this afternoon — don’t agree with everything, but I need to do some quality thinking about some of the feedback that my nurse manager gave me. Would love your input. When can we meet to discuss?”

• Ashley, a recent nursing school grad, works on a pediatric hematology unit. At the end of each day, she writes down her reflections about what’s happened at work and what she’s feeling.

• Rob works the evening shift on a busy med/surg unit. Before taking a phone call from a physician who has a reputation for being abrasive, Rob takes a few deep breaths and visualizes himself speaking calmly and slowly.

• Yolanda is a hospice nurse with years of experience. At the beginning of each workday, she takes a few minutes to center herself by meditating.

Although these nurses work in different practice settings and have varying amounts of work experience, each of them is exhibiting a characteristic of emotional intelligence.

Early psychologists who studied intelligence focused on memory and problem-solving, yet at the same time there were researchers who believed that noncognitive aspects of intelligence were also important life skills.² Cognitive and noncognitive abilities are related. Specifically, the abilities to manage emotions and handle stress are important predictors of career success.³ Cognitive intelligence or IQ by itself is not a good predictor of job performance.³ In fact, studies estimate that IQ accounts for only between 4% and 25% of success in job performance.³

When nurses begin their careers, they focus on perfecting “hard skills,” such as IV line management and other technical skills. Those with good clinical skills often progress well through the early stages of their careers. However, if they don’t also develop “soft skills,” they may find their promotional opportunities limited or even find their nursing career unsatisfying.⁴ Developing the ability to be aware of and appropriately manage your emotions, persist despite difficulties, and develop good working relationships with your colleagues may end up being more important than having a few extra IQ points.

Is your limbic system running your life?

The amygdala and the hippocampus are two important limbic system structures. The amygdala is the specialist for emotional matters; the hippocampus has important memory functions, especially for events that are threatening, such as making a serious medication error. An animal that has had its amygdala removed loses the ability to sense fear and rage, is unable to cooperate or compete with others, and has emotional responses that are blunted — or even absent.⁵

Because these reactions are vital to protect us from danger, the amygdala reacts more quickly than the more sophisticated cerebral cortex. Thus, the amygdala can trigger an emotional response before the more fully informed cortical centers have fully understood what is happening and have had time to mount a rational response.⁵

Inside emotional intelligence

According to Goleman, EI has five components: self-awareness, self-regulation, motivation, empathy, and social skill.^5,6 Self-awareness, self-regulation, and motivation are self-management skills. People who are self-aware not only are able to recognize and understand their emotions and moods, but also are able to appreciate how their emotional behaviors affect other people. People with high self-awareness are usually confident and see themselves realistically. For example, a nurse interviewing for a position in a blood donor center demonstrates self-awareness when she tells the interviewer that she will need to develop the ability to feel confident in working in a room where her venipuncture skills will be witnessed by many people. EI is more than being able to roll with the punches or communicate a sense of empathy for other people. EI is a genuine ability to respond emotionally to others, to understand what others are feeling, and to move forward in a constructive way.⁴ Having EI helps us succeed in a complex world.⁴

Think before you jump

People who have a high degree of self-regulation have the ability to control inappropriate impulses and to think before acting. People who have little self-regulation often overreact to situations without processing information. People who have developed self-regulation skills still feel distressing emotions, such as anger, anxiety, sadness, and distress, just as anyone else. The difference is that emotionally intelligent people have found ways to manage their emotions and even to direct them in productive ways.⁶

Self-regulation can be compared to an ongoing inner conversation that encourages emotional control. For example, a burn survivor taught disfigured people to engage in “self-talk” before they went out in public. Through this private internal pep talk, people who avoided going out in public began to gain increasing confidence in rehearsing and managing situations in which others might stare or ask questions about their physical appearance. The ability to self-regulate emotions is particularly important for people in management and leadership positions because being able to control their impulses and manage their feelings allows them to create a trusting work climate.⁶

People who are highly motivated have a passion for their work. Their strong desire to achieve is what makes them jump out of bed and to go work. Highly motivated people are also optimists. Even when faced with obstacles that would discourage others, they persist in working toward positive goals.

Empathy loves company

Nurses need empathetic and social skills to effectively manage relationships with others.⁶ People who have developed empathetic skills are able to read the emotions of others and are skilled at managing people based on their emotional reactions. Two characters from the television series “Star Trek: The Next Generation” are contrasts in empathy. Deanna Troi, the ship’s counselor, has such highly honed empathetic skills that she “senses” the emotions of others before they are even aware of them. The android character, Data, was programmed to have only cognitive intelligence. As a result, Data lacks the capacity for feeling and is thus oblivious to the emotions of others. Nurses often use their Deanna Troi abilities in working with patients and families, but may have less awareness of and sensitivity to distress in colleagues.

The ability to listen empathetically is especially important for leaders. For example, when staff members raise concerns to nursing management, they seek both a solution and an empathetic response. A nurse leader who controls a discussion by not allowing staff to talk or shows disdain by being unresponsive or not making eye contact is unable to communicate empathy.

People with highly developed social skills have specific “people skills.” They have a well-developed sense of how to relate to many types of people and how to build networks. People who have developed social skills are usually friendly, although Goleman describes social skill as “friendliness with a purpose” — that is, the ability to get people to cooperate with you — whether that’s agreeing to trade a day off with you or helping you with a challenging patient assignment.⁶ Goleman’s latest book, Social Intelligence, further explores the emerging field of neuroscience. Social intelligence focuses on learning how our brains connect with other people and how we can enhance interpersonal connections.⁷

Goleman also describes human emotions as being contagious and suggests that we can “catch” other peoples emotions the way we “catch” a cold.⁷

What’s in it for nurses?

Nursing is the epitome of a “high-tech, high-touch” profession. Every day, nurses devote their energies to meet the physical, psychological, and emotional needs of patients under their care. Patients and their families rely on nurses as important sources of emotional support.⁸ Moreover, nurses are expected to present a professional and caring demeanor irrespective of events in their personal lives. The physical toll of providing direct patient care is well recognized, but the emotional demands of nursing may be underestimated or even ignored.⁸ Experts describe “emotional labor” as the process of regulating what you feel and how you express what you feel to meet workplace expectations.⁹ “Display rules” are standards of emotional behavior that nurses are expected to demonstrate in public.⁹ Display rules for nursing include showing concern and empathy for patients, demonstrating a calm and collected demeanor when dealing with an angry family member or a verbally abusive physician, and responding with confidence to a crisis.

A nurse’s ability to meet these extraordinary demands requires a high amount of emotional work; those who have difficulty often experience job stress and burnout.⁸ Learning how to work in a more emotionally intelligent way can help make nurses more resilient to the profession’s high emotional demands.

Boost your EI

Recent neurobehavioral research on the limbic system indicates that EI can be learned through motivation, practice, and feedback.⁶ The most important fact to remember is that you can choose how to respond to emotionally charged situations.

Nurse researcher Joan M. Vitello-Cicciu, RN, PhD, FAAN, has investigated EI and its relevance to nursing.9 One of her studies showed that nurse leaders ranking high in EI had several things in common: They read self-help books, practiced meditation, and used a variety of stress management techniques to help manage their emotions. They also developed specific strategies, such as not taking things personally and expressing empathy for others, to help them enhance their emotional intelligence skills.⁹

To improve your ability to identify and perceive emotions, practice observing verbal and nonverbal expressions of other people and then validating your impression of their feelings with them.¹⁰ You can also ask your colleagues to give you feedback about the consistency between what feelings you intend to communicate and what you are actually communicating.⁹

To learn more about your emotional state, use self-reflection techniques. You might want to keep an emotional reflection journal. Through journaling, you can pose questions to yourself about what you felt in a particular situation, how you responded to the emotional stimulus, and how you might modify your response in the future.

If you’re focusing on understanding and managing emotions, consider role playing emotionally challenging situations and analyzing what transpired in the emotional exchange. Ask your colleagues to help by listening and validating emotional experiences. Some staffs or units find ways of allowing discussions of emotionally charged events.⁸

To help learn how to manage your emotions, practice skills such as calming or centering yourself before a stressful event. Deep breathing, physical exercise, meditation, and visualization techniques that allow you to picture yourself handling a difficult emotional situation in a positive way will help you develop your emotional intelligence.

Be aware of situations in which your emotions take the lead and your rational mind is left with the consequences. Reacting emotionally can, in some situations, seriously limit your career potential and job satisfaction. For example, don’t resign from a position by sending a resignation letter that is highly critical of your organization and the people who work for it. If your organization asks your reason for leaving in an exit interview, honestly but tactfully provide an explanation. Learn to deal with conflict appropriately — a person with EI strives to be seen as a rational professional willing to work with others to resolve conflicts.

A good exit strategy

Consider practicing how to exit from any situation in which you feel you may not be able to control your emotions. You almost always have the choice to say, “I need a few minutes.” Learn how to express your frustrations or negative emotions in a way that is acceptable in the workplace. Don’t put anything in writing, including e-mail that you wouldn’t be willing to have displayed on your organization’s bulletin board. If you wish to express angry feelings in writing, make a draft and put it away for several days before deciding to send or amend it. This will give you time to reflect on your feelings. Or, find another way of expressing your feelings.

Smarts — with a difference

EI is a different way of being smart. Enhancing your ability to be self-aware, optimistic, and empathetic can increase job satisfaction and productivity both at work and in other areas of your life. The workplace is a prime area to work on improving EI skills because work plays such a central role in the lives of nurses. We spend a large percent of our waking time at work, and often our experiences at work significantly affect our identify and self-esteem.

Learning how to improve your EI requires a lifestyle change. Reading an article or attending a seminar can make you more aware of the value of EI, but developing your skills takes practice and commitment for the long term. The Consortium for Research on Emotional Intelligence in Organizations provides a comprehensive list of EI resources, including many books and links to other sites that can help you use emotional intelligence to enhance your personal and professional success.