Foltin Keller 2012 EI

Leading change with

emotionalintelligence

20 November 2012 • Nursing Management www.nursingmanagement.com

Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

By Anne Foltin, MA, RN, NE-BC, and Ronald Keller, MPA, BSN, RN, CCRN, NE-BC

www.nursingmanagement.com Nursing Management • November 2012 21

What happens when a hospital unit is faced with what appears to be insurmountable changes in a short period of time? In 2008, the Cardiac and Vascular unit at NYU Langone Medical Center (LMC), a large urban

academic medical center, experienced a 30% increase in patient volume. At the same time, the unit transitioned from a general

cardiac unit to one that specialized in pre- and postcardiac cath-eterization and electrophysiology patients. This required the redefining of roles and responsibilities of staff members on

the unit. We also needed to create fluid and efficient systems for the increased patient volume, as well as initiate extensive workflow changes to meet the demands of a dedicated unit for this population. Some of the challenges we faced were

improving first case start times, ensuring patient readiness for procedure, facilitating patient flow, increasing

procedural area efficiency, and improving procedure room utilization. At first the magnitude of change seemed overwhelming, especially considering the substantial staff resistance we encountered. Despite this resistance, within 1 year, we had transitioned successfully to a pre- and postcardiac procedural unit, meeting all our goals while increasing staff and patient satisfaction.

The key to our success was emotionally intelli-gent leadership. Although leading effective change requires a number of factors, including cognitive

intelligence and organizational savvy, emo-tional intelligence (EI) was the decisive

factor in our success.



Leading change with emotional intelligence

The domains of EIEI is essential for a leader’s suc-cess.1 It’s the most important ingre-dient contributing to increased morale, cooperation, teamwork, motivation, and a positive work environment.2 EI is the ability to perceive and regulate your own emotions and other’s in a way that positively influences communica-tion, motivation, and teamwork.3 It’s the capacity to achieve the best-possible results from relation-ships.4 EI isn’t merely a function of personality or a person’s pre-ferred mode of behavior; cognitive ability is central to its premise.3 A person with EI is able to integrate cognitive processes and feelings to intelligently adapt their behavior and manage situations.

There are five integrated domains of EI: self-awareness, self-regulation,

motivation, empathy, and social skill.5 (See Table 1.) These categories are considered integrated because one domain isn’t successful by itself. For example, self-regulation isn’t possible without an awareness of your emotions, how they’ll affect others, and the communication component of social skills, which is necessary to motivate others.

Evidence indicates that leaders who have EI are more effective.6-8 Early research came primarily from the field of organizational behavior. In a study of 70 managers in private sector organizations, it was noted

that EI significantly correlated with effectively leading change.7 Results from a later study of 40 senior man-agers supported this finding and also found that EI may help predict leadership potential.8 Leaders who demonstrated EI were more suc-cessful in meeting management objectives and were viewed as more effective leaders by their direct reports.9

Research within the nursing pro-fession has had similar results. In a study of over 6,000 nurses employed at acute care facilities in Alberta, Canada, nurses working with emo-tionally intelligent leaders reported increased quality of patient care, greater teamwork, and more job sat-isfaction than nurses working with leaders lacking EI.10 These effective leaders demonstrated EI by listening with an empathetic response and

remaining supportive during times of turmoil. They perceive and feel oth-ers subtle actions rather than words.

At LMC, we applied the domains of EI to successfully navigate the phases of introducing, implement-ing, and sustaining change on our unit.

Phase 1: Introduction to changeSocial skills are critical when pre-senting change to staff. Rather than taking a didactic approach, we began by engaging the staff in a conversation about the challenges we were facing on the unit, includ-

ing the increased patient volume and specialization of services, and what this meant for staff and patients. We laid the groundwork by talking about what the current situation was, specifically how our systems were being overwhelmed by the recent dramatic increase in patient numbers and acuity. We knew that staff members were already feeling stressed by the increased demands, and this allowed them to voice their frustrations and acknowledge the need for change. We then led them in a conversation about what changes were needed and the positive effects they would have on workflow on the unit and the quality of care the patients received.

Creating an environment of open and safe communication is essential when changes are being introduced

to an organization. When faced with change, it’s not unusual for staff to react with resistance and skepticism. Empathy allows the emotionally intelli-gent leader to recog-nize that these responses are often a reflection of

underlying fear and uncertainty. When we introduced the proposed changes to our staff members, we didn’t react to their anger, try to persuade them that their views were wrong, or insist that they’d have to adjust. Instead, we listened and validated their feelings and concerns. We did this while staying consistent in our message that the change would happen.

We also introduced the proposed changes months before we imple-mented the systems transformation, giving staff time to go through a process of acceptance. During the

The domains of EI will prepare leaders to engage with staff, build commitment, forge working relationships, and increase staff satisfaction.



intervening months, we maintained an open-door policy and continued to encourage staff members to talk about their concerns and make suggestions related to the unit’s transformation.

Phase 2: ImplementationOvercoming resistance to change demands all the resources of an emotionally intelligent leader. Empathy helps a leader anticipate and understand staff reaction. Self-awareness and self-regulation help a leader, faced with dishar-mony, manage his or her own feelings of frustration and consis-tently respond in a manner that promotes collegiality and collabora-tion. Social skills and the ability to motivate others are necessary to guide staff members through nega-tivity to a place where they’re not only receptive to change, but actually become actively engaged in the process.

Theory into practiceIt can be particularly difficult for a leader who has enjoyed a collegial relationship with staff to handle the anger and conflicts that can arise during times of intense change. Self-awareness and self-regulation are needed to recognize and moderate your own uncon-structive reactions. For example, one manager realized that she had a tendency to internalize the staff members’ reactions, which would lead her to question the change process and her own part in it. Understanding that her doubts were related to her desire to have a satisfied staff, and reminding herself that the dissatisfaction was generated by the disruption of change and not related to her personally, allowed her to refocus on the goals and stay committed to the vision of change.

It’s just as important to be aware of your strengths as a change agent. The same manager who tended to internalize reactions also realized that one of her greatest strengths as a leader was her ability to build positive relationships with staff, which requires social skills and empathy. Knowing all staff members enabled her to individual-ize the approach she used for each person and adjust her actions for variations in personalities. She was also able to use staff member trust to keep communication open and support them during particularly difficult periods of implementation.

Sometimes the best action is no action. Self-regulation gives a leader time to step back and reflect, which can lead to better decisions and more effective actions. We anticipated resistance from staff and decided not to immediately react to individual events throughout the day. Instead, we met at the end of our shifts to review the day’s events, progress made, and problems encountered. We then strategized how best to address any problems and capitalize on successes, fine tuning our overall approach rather than engaging in disconnected or inconsistent reactions to isolated incidents.

From resistance to engagementThe goals of successful implementa-tion go beyond merely overcoming resistance to generating enthusiasm and commitment on the part of staff. We used two strategies to achieve this: the first was to create an envi-ronment of success and the second was empowering staff to lead the change effort. Motivation and social skills were of primary importance with both these strategies.

Knowing that implementation was going to continue over an extended period of time, we felt it was important to instill a sense of success early on in the change pro-cess. Small steps toward our goals were acknowledged with celebra-tion lunches on a regular basis. Staff efforts, even small ones, were rewarded with expressions of gratitude and compliments.

Motivational triggers differ among people; an emotionally intelligent leader uses empathy and social skills to recognize and use what works best for each indi-vidual. Encouragement and recogni-tion must be timely, authentic, and specific to an individual. For exam-ple, some nurses enjoyed receiving public recognition for their contribu-tions and accomplishments, whereas others preferred more personal one-on-one acknowledgement.

Table 1: Domains of EI• Self-awareness is having insight into your own emotions, strengths, and

weaknesses and how your feelings affect others.• Self-regulation is the ability to control your impulses, mold your moods con-

structively, and withhold judgment until enough information is gathered.• Motivation is the drive to be creative, seek challenges, actively search for

solutions to problems, and pursue goals with energy and commitment.• Empathy is the ability to understand others’ feelings and emotions when

making decisions. Empathy is particularly important when leading change, building a team, and creating a sense of loyalty in team members.

• Social skill is the ability to manage and forge relationships with others. Leaders with persuasive communication skills can overcome differences and build networks that will enable a vision to be accomplished.

Source: Strickland D. Emotional intelligence: the most potent factor in the success equation. J Nurs Adm. 2000; 30(3):112-117.




EI has been linked to high levels of empowerment among team members, which is crucial because empowerment has a positive effect on job satisfaction and can lead to engagement.11-13 The emotionally intelligent leader will respond to staff needs by providing access to resources, support, and opportunity, thus adding to staff perception of empowerment. The degree of staff engagement will directly impact enthusiasm, motivation, and how challenges are met. Empowered staff members demonstrate persis-tence, a more positive outlook, and promulgate a more proactive, inno-vative culture. An emotionally intelligent leader is able to recog-nize and provide the support and resources each staff member needs to feel empowered.

We empowered staff from the beginning to lead the change effort by giving them the tools and autonomy they needed. For exam-ple, before unit transformation, the responsibility of preparing patients for their procedures fell to the clin-ical resource nurse, who also had numerous other duties coordinat-ing patient care on the unit. There was also no designated area where patients were prepared, so the nurses were frequently interrupted and maintaining privacy was diffi-cult. To facilitate patient flow and enhance quality of care, we needed to create a prep nurse position and a dedicated preparation room.

All nurses were oriented to the prep nurse position and were assigned on the timesheet. When a nurse was assigned to the prep role, he or she would have to come in 2 hours earlier than the usual start time. This shift change was met with contempt. Additionally, the location of the prep room was far away from the nurses’ station and perceived as an inconvenience for the prep nurse.

To overcome the strong initial resis-tance, we presented this change to the staff members as an opportunity for them to define a new role and design a new workspace. As long as they met the goals of improving workflow and quality of care while staying within regulatory and hospi-tal guidelines, we encouraged them to be innovative and try various approaches to improve upon the role. We made sure they had the information, supplies, equipment, and assistance they needed and then stepped out of the way. As they worked on setting up the room and creating a process for patient flow, they became invested in the out-comes and enthusiastic about mak-ing it successful. Over time they redefined the prep nurse role from one focused on clinical tasks to a more substantial one that encom-passed patient and family education and support.

Recognizing and responding to emotional transitions is one of the keys to guiding staff.3 Throughout the implementation process, we maintained an open-door policy, ensuring the nurse managers’ office was a safe haven for staff members to come and talk about their feelings and fears or make suggestions and give their input. The nurse manager used empathy and social skill to connect with each nurse individually. We made a particular effort to engage those who were more vocal in their protests, always with a positive approach. We acted to ensure that frustration didn’t transition to anger and initial resistance didn’t become entrenched, delaying or even pre-venting successful change. Rather, we made an effort to nurture any positive feedback we received from staff, facilitating an emotional tran-sition from frustration to satisfac-tion.

We also held impromptu meet-ings with the entire staff where we shared our progress. Everyone was encouraged to voice concerns and make suggestions. Besides the impromptu and regularly scheduled meetings, we maintained continu-ous informal feedback between leadership and staff.

Phase III: Establishing the new normThe change process isn’t completed until it becomes the new norm. A leader must maintain momentum generated during the initial imple-mentation phase and prevent staff from slipping back into old rou-tines. During this period, social skill and motivation continue to be essential. We kept staff engaged in improving the new process and continued to celebrate and build on successes. For example, one of our early successes was improvement in the clinical resource nurse role. The nurse assigned to this role could now focus on its intended purpose: managing patient flow, assisting colleagues with clinical emergen-cies, and addressing administrative issues. Patient preparation could be done in private and the nurse had time to educate the patient and address their concerns. We high-lighted improvements in patient-satisfaction scores and procedural start times.

In healthcare today, change is the only constant. Managers are accountable for building relation-ships, fostering resilience, and lead-ing staff through the ups and downs of the change process. Utilizing EI can help managers be successful leaders. The domains of EI will pre-pare leaders to engage with staff, build commitment, forge working relationships, and increase staff satisfaction. Incorporating the domains of EI into our leadership



style laid the foundation for the trust and agreement of the staff to willingly accept new ideas for unit transfor-mation. The benefits from integrating the domains of EI into our culture are that staff members independently initiate, implement, modify, and sustain efforts for improvement in all aspects at LMC. NM

REFERENCES 1. Goleman D. What makes a leader? Clin Lab Manage Rev. 1999;

13(3):123-131. 2. Strickland D. Emotional intelligence: the most potent factor in the

success equation. J Nurs Adm. 2000;30(3):112-117. 3. Vitello-Cicciu JM. Exploring emotional intelligence: implications for

nursing leaders. J Nurs Adm. 2002;32(4):203-210. 4. Marquis BL, Huston CJ. Leadership Roles and Management Func-

tions in Nursing: Theory and Application. 6th ed. Philadelphia, PA: Wolters Kluwer Health; 2009.

5. Goleman D. Emotional Intelligence: Why It Can Matter More Than IQ. New York, NY: Bantam Books; 1995.

6. Dulewicz V, Higgs M. Leadership at the top: the need for emotional intelligence in organizations. Int J Organizational Analysis. 1993;11(3):193-210.

7. Higgs M. Do leaders need emotional intelligence? A study of the relationship between emotional intelligence and leadership of change. Int J Organisational Behaviour. 2002;5(6):195-212.

8. Higgs M, Aitken P. An exploration of the relationship between emotional intelligence and leadership potential. J Managerial Psy-chology. 2003;18(8):814-823.

9. Rosete D, Ciarrochi J. Emotional intelligence and its relationship to workplace performance outcomes of leadership effectiveness. Lead-ership & Organization Development J. 2005;26(5):388-399.

10. Cummings G, Hayduk L, Estabrooks C. Mitigating the impact of hos-pital restructuring on nurses: the responsibility of emotionally intelli-gent leadership. Nurs Res. 2005;54(1):2-12.

11. Manojlovich M, Spence Laschinger HK. The relationship of empow-erment and selected personality characteristics to nursing job satisfaction. J Nurs Adm. 2002;32(11):586-595.

12. Morrison RS, Jones L, Fuller B. The relation between leadership style and empowerment on job satisfaction of nurses. J Nurs Adm. 1997;27(5):27-34.

13. Lucas V, Laschinger HK, Wong CA. The impact of emotional intelli-gent leadership on staff nurse empowerment: the moderating effect of span of control. J Nurs Manag. 2008;16(8):964-973.

At the NYU Langone Medical Center in New York, N.Y., Anne Foltin is a nurse manager on the Invasive Cardiology Unit and Ronald Keller is a senior director of Nursing, Cardiac, and Surgery.

The authors have disclosed that they have no financial relationships related to this article.

DOI-10.1097/01.NUMA.0000421675.33594.63


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