The Role of Emotional

Intelligence in Perioperative
Nursing and Leadership: Developing
Skills for Improved Performance
KATHY WILLIAMS BEYDLER, MBA, RN, CNOR, CASC

ABSTRACT
Many responsibilities of perioperative professionals involve concrete tasks that require high technical
competence. Emotional intelligence, referred to as EQ, which involves the ability to relate to and
influence others, may also be important for perioperative professionals. High EQ has been linked to
higher performance in the workplace, higher job satisfaction, lower turnover intentions, and less
burnout. Perioperative professionals who demonstrate a combination of technical skills and EQ
could be more attuned to the humanity of health care (ie, providing more holistic care for the patient).
Perioperative nurses who value providing holistic care for their patients may possess many of the
elements of EQ. Leaders who recognize the importance of their own EQ and actively assist staff
members to enhance and develop their EQ competency may help to create a competitive advantage
by establishing a workforce of nurses who possess strong technical skills and high EQ. AORN J 106
(October 2017) 317-323. ª AORN, Inc, 2017. http://dx.doi.org/10.1016/j.aorn.2017.08.002
Key words: leadership, emotional intelligence, job performance, leadership training.

T he perioperative environment is changing. Years

ago, competencies for perioperative nurses were
heavily weighted toward technical skills. Today,
an emphasis on technical skills alone may not ensure success as
a perioperative nurse. Patients and their family members not
organization forward toward a common goal and can differ-
entiate star performers from mid- or low-level performers.1

Developing EQ is important for both staff nurses and nurse

only are active participants in their health care but are
considered health care consumers. It is essential that periop-
erative leaders educate staff members in the art of emotional
intelligence (referred to as EQ) and hire nurses not only for
their technical skills but also for their EQ skills. Emotional
intelligence is the ability to influence and motivate people by
being attuned to their needs, effectively handling conflict, and
creating an environment in which everyone can work at their
best level.1 Emotional intelligence in action can move an
http://dx.doi.org/10.1016/j.aorn.2017.08.002
ª AORN, Inc, 2017.
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leaders because EQ has been associated with a variety of
benefits. In a literature review, Bulmer Smith et al2 found that
EQ has been linked to clinical decision making, collegial and
interprofessional relationships, and proper use of knowledge in
the clinical environment; additionally, EQ was found to be
essential to nurses who want to form genuine, authentic, and
compassionate relationships with their patients. The authors
stated that a nurse leader with high EQ may be able to
influence staff performance and patient care by establishing
positive relationships with team members and by using his or
AORN Journal j 317
Beydler
her passion and enthusiasm to motivate nurses to provide
high-quality patient care.
The benefits of EQ for perioperative leaders and nurses reach
beyond patient care and can positively affect the workplace. In
a 2011 meta-analysis, O’Boyle et al3 reported a correlation
between high EQ and high job performance. A 2014 study by
Ngirande and Timothy4 found a significant relationship
between a leader’s EQ and employee job satisfaction. A staff
nurse’s level of EQ is also important to consider because
employees with higher EQ have been found to have higher job
satisfaction, greater organizational commitment, and lower
likelihood of intention to leave their place of employment.5
A 2011 study by Weng et al6 found that physicians with
higher self-rated EQ experienced significantly higher job
satisfaction and less burnout. Similarly, G€orgens-Ekermans
and Brand7 found that nurses with high EQ reported signif-
icantly lower job stress and burnout. The ability of the peri-
operative nurse leader to influence the health care team may
depend on understanding and embracing his or her own EQ.
Therefore, EQ training should begin with leaders and filter
to nurses.
Perioperative leaders and nurses should be examples of the
humanity of health care (ie, providing holistic care based on
truly caring for the patient and seeing him or her as a person),
while also providing technically competent care based on
clinical expertise. Developing EQ can result in viewing the
patient not only as part of a procedure but as a person who
needs both technical skills and personal kindness. Consider the
experience of a patient being transported to surgery. Along the
way, the nurse talks to the patient and seems to take a genuine
interest in her and her upcoming surgery. After talking and
seeking to understand the patient’s concerns, the nurse can
sense that the patient is afraid of undergoing surgery. Before
the nurse leaves the bedside, she leans down to give the patient
a hug, which the patient finds to be comforting. The nurse in
this scenario sees beyond the task of transporting the patient to
surgery and instead sees the patient as a person who is
concerned about her surgical outcome.
In the 1973 article “Testing for competence rather than for
‘intelligence,’”8 McClelland discussed the traditional intelli-
gence quotient and what would become known as EQ.
McClelland stated that it is critical to be able to understand a
setting and to respond appropriately to what is happening in
that setting,8 which is a component of EQ that is critical in
the OR environment. Consider a procedure in which, when
the relief RN circulator enters the room, the scrub person,
surgeon, and anesthesia care provider are quiet. It appears to
be a difficult procedure. The relief RN circulator’s ability to
318 j AORN Journal
October 2017, Vol. 106, No. 4
read the situation and respond appropriately (eg, maintain
the quiet environment) can make a critical difference in the
outcome for that patient. In this scenario, the relief RN
circulator needs to be aware of the nonverbal cues of EQ,
which can include a single look, motion, or eye movement to
communicate ideas. During a procedure in which all of
the participants are wearing masks, nurses may often rely
on nonverbal cues to determine what the surgeon or
scrub person needs. This unspoken communication may
come in the form of a lifted eyebrow, a gesture, or a nod of
the head.
DEVELOPING THE ELEMENTS OF EQ
Several key attributes are present in individuals who possess a
high EQ, including self-awareness, self-management, empathy,
and social skills (Table 1). The first step toward developing
these attributes is to assess one’s current state.9 This can be
accomplished by completing an honest personal inventory.
The Consortium for Research on Emotional Intelligence
in Organizations offers multiple options for EQ tests that
perioperative leaders or nurses may consider taking to
assess their EQ.10 After taking an assessment, nurses
should consider ways to further assess and develop their EQ
attributes.
Self-Awareness
People who are self-aware possess the ability to honestly and
openly assess themselves and recognize not just their strengths
but also their areas for improvement. Self-aware leaders seek
constructive criticism and are open to both positive and
negative feedback. Those who are not self-aware may believe
that no one will notice their weaknesses, when in fact the
opposite is true. Self-aware leaders take personal responsibility
for their actions, including their mistakes.9,11 Consider a
scenario in which the surgeon asks for a suture that the scrub
person did not pull or open to the sterile field. The RN
circulator scrambles to get the suture from outside the room,
while the scrub person makes a conscious choice either to take
responsibility for the missing suture or to make excuses. The
RN circulator has the same choice when returning with the
suture. A self-aware team member would take responsibility
for his or her own mistake in this situation.
Self-aware leaders view obstacles as opportunities and remain
positive in the face of challenges. Additionally, people who are
self-aware may be more self-confident1 and may have no need
to be the center of attention. They operate with a quiet
confidence, publicly acknowledge the accomplishments of
others, and let their work speak for itself.
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October 2017, Vol. 106, No. 4
Table 1. Elements for Success in Developing Emotional Intelligence
Attribute
Self-awareness
Self-management
Empathy
Social skills
References
1. Goleman D. Leadership: The Power of Emotional Intelligence. Selected Writings. Northampton, MA: More Than Sound LLC; 2011.
2. Goleman D. How to be emotionally intelligent. New York Times. April 7, 2015:ED17. http://www.nytimes.com/2015/04/12/education/edlife/
how-to-be-emotionally-intelligent.html?_r¼0. Accessed July 20, 2017.
To begin developing self-awareness, individuals should seek
authentic feedback and constructive criticism from colleagues
who are trusted to have an interest in the individual’s long-
term growth.1 Instead of being defensive, nurses should view
performance appraisals and feedback as a method to increase
self-awareness and actively listen to the feedback and consider
what may need to be improved.9 Emotionally intelligent
nurses should take responsibility for all actions (including
mistakes) and be aware of excessively and publicly seeking
attention and instead begin to credit others. A leader who
consistently acknowledges the work of direct reports may gain
the trust and respect of the staff members and leadership
colleagues, and this behavior could also create loyalty and a
positive atmosphere for the team overall.
Self-Management
Leaders with advanced skills in self-management are achievers,
are passionate about their work, and are highly motivated.
They are not content with the status quo but are relentless in
seeking improvements and will embrace change. People who
possess a large number of self-management skills may be more
in control of their feelings, exhibit the capacity to adjust to
www.aornjournal.org
Emotional Intelligence
1,2
Elements for Success

Seek constructive feedback

Accept both positive and negative feedback openly

Take personal responsibility for actions

View obstacles as opportunities

Recognize not only strengths but also areas for improvement

Seek improvement opportunities relentlessly

Show flexibility in managing change

Control feelings and remain calm in stressful situations

Demonstrate optimism

Remain proactive

Develop trustworthiness in keeping commitments

Experience the feelings, thoughts, and attitudes of others

Use the understanding of others to influence actions

Actively listen and learn from others

Ask questions to seek understanding

Mentor others

Collaborate and find common ground

Develop connections beyond immediate areas of responsibility

Develop and use negotiation skills

Generate positive motivation for the team through passion for work
change, and remain calmer than those who do not possess self-
management skills.11,12 Impulsive behavior is not one of their
traits, and they are not easily angered or prone to emotional
outbursts.11,12
Consider the experience of a young perioperative nurse man-
ager who works for an accomplished director with the vision to
make a difference. The manner in which the director attempts
to share that vision with her team in meetings is problematic,
however. The director often raises her voice and is prone to
outbursts. This behavior shows a lack of development in self-
management,12 and although it is exhausting to her direct
reports, no one speaks up. The young nurse manager makes an
appointment with the director and nervously discusses her
concerns regarding the director’s communication style and its
effect on the nurses. They come to an understanding of what
the nurse manager needs to be successful in reporting to the
director, and in doing so, to make the director successful.
Through the use of self-evaluation, as suggested by Dye,13 the
director and the manager find common ground and are able to
work effectively together, and the director educates the
manager about perioperative nursing management. Self-
management may help create an environment of trust in
AORN Journal j 319
Beydler
which politics and conflicts are minimized and productivity
is improved.1
It is best for nurses and nurse leaders to remain calm in the
face of stressful situations. Change is not easy, and leaders
seeking to increase their skills in self-management embrace
change and willingly contribute to the improvement process.14
For example, many nurses and nurse leaders can relate to a
contentious OR committee meeting. Although the natural
tendency of those attending the meeting may be to be
defensive, nurses and nurse leaders should consider the idea
the group is discussing and take time to reflect before reacting.
Empathy
Empathetic leaders experience for themselves the feelings,
thoughts, and attitudes of others and use that experience to
influence their own actions. Another key element of empathy
is the willingness to learn from others by actively listening and
asking questions.15 Empathetic leaders possess the ability to
observe and interpret body language and to focus on those
nonverbal cues. Empathetic leaders show that they are inter-
ested in their staff members and spend time mentoring them
to reach their goals. By creating an emotional connection with
their employees, the leader develops loyalty and builds trust.
Employees who work with highly empathetic leaders could
have a higher level of satisfaction with work that translates to
retaining talent for the organization.1 Throughout their ca-
reers, many nurses are fortunate to work with a leader who
genuinely shows concern about them and who willingly gives
specific feedback and actively mentors others. Building a
relationship with a leader who is willing to mentor may be
valuable throughout a nurse’s career.
Consider a scenario in which a nurse is at the point of burnout
with sick patients, impatient physicians, and a health care
system that he perceives to be difficult to manage. His
response, formed out of frustration, may come across as
negative and demanding. This is an opportune time for the
nurse leader to be observant of the emotional cues the nurse is
exhibiting and to provide support for his feelings.16 Finding
common ground with him will help defuse the situation and
provide support to the nurse while a solution to the problem
is sought.
Nurses demonstrating empathy begin to actively listen to
others before forming a response.1 Active listening includes
being fully focused on what is being said without mentally
forming counterarguments while the person is speaking.
Another tip for active listening is to rephrase what the speaker
has said in the listener’s own words. For instance, the listener
320 j AORN Journal
October 2017, Vol. 106, No. 4
could open a response with This is what I understood you to say.
Such an exchange gives the speaker the opportunity to correct
or confirm the communication.1
Nurses should watch the body language of others to seek to
understand the unspoken message in nonverbal communica-
tion and take the opportunity to become aware of their own
body language and the corresponding message it is sending.17
Surgical patients may be anxious and fearful and may feel a loss
of control; however, patients may not express these negative
feelings verbally. Nonverbal communication that could indi-
cate patient anxiety may include frowning, fidgeting, lack of
eye contact, and movement of extremities.17,18 To provide
holistic care aligned with the humanity of health care, nurses
must be aware of these nonverbal signals from patients and use
this understanding to influence the plan of care for patients. In
addition, a nurse’s facial expressions, posture, actions toward
the patient (eg, moving away from the patient), and lack of eye
contact may indicate that the nurse is not fully engaged in the
conversation or is rushed. Conversely, a simple reassuring
touch, handshake, or smile can convey warmth to the patient,
which has been associated with greater patient satisfaction.19
Nurses should ask themselves, Does my nonverbal communication
project the message I am seeking to convey?
Social Skills
Social skills are a culmination of the other EQ skills in
action.20 Developing negotiation skills can be important to
improve one’s social skills. Negotiating with sales representa-
tives, vendors, or anesthesia care providers to create a mutually
beneficial solution for the patient and for both negotiating
partners presents an opportunity to hone these skills. Leaders
with high EQs exhibit social skills that may enable them to
collaborate and find common ground with others,1,11 which
can be especially challenging in the fast-paced, high-stress
perioperative environment.
It can be challenging to communicate in the silo environment
of health care.21 Perioperative services has its own distinct silos
(eg, business office, preadmission testing, outpatient surgery
unit, preoperative holding, sterile processing, inpatient sur-
gery, postanesthesia care unit). Success of the perioperative
team lies in the ability to adequately communicate with in-
dividuals in these areas. An understanding of the value of the
work that others perform is crucial to this process and to the
delivery of patient care. To foster this understanding, leaders
can offer training to develop staff members’ EQ skills.
Rather than working in a silo, emotionally intelligent leaders
network and develop connections and relationships beyond
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October 2017, Vol. 106, No. 4 Emotional Intelligence

Table 2. Wage Commitment for Proposed Emotional Intelligence Training

Staff Average Wage Training Hours: Quarterly Wage Commitment for Wage Commitment for
Category Per Hour1 and Annually After Each 2-hr First Year (4 Quarters)
First Yeara Training Session
Staff RN $33.32 (<10 ORs) 2 $66.64 $266.56
Nurse manager $40.43 (<10 ORs) 2 $80.86 $323.44
Director $48.70 (<10 ORs) 2 $97.40 $389.60
Staff RN $33.17 (>10 ORs) 2 $66.34 $265.36
Nurse manager $44.95 (>10 ORs) 2 $89.90 $359.60
Director $62.88 (>10 ORs) 2 $125.76 $503.04
a
Proposed training schedule is 2 hr per quarter in the first year of training, followed by 2 hr annually after the first year of training.
Reference
1. Bacon DR, Stewart KA. Results of the 2016 AORN salary and compensation survey. AORN J. 2016;104(6):486-501.

the areas for which they are responsible. This widens their
scope of influence and creates an environment of cooperation.
Leaders with developed social skills readily build rapport with
individuals and can create esprit de corps (ie, pride, fellowship,
and loyalty) within teams. Leaders’ keen social skills allow
them to more easily get work done through others, moving the
organization forward.12 In addition, leaders’ passion for work
could generate positive motivation for the team.
Consider a scenario in which a potential job candidate for a
leadership position states that she is not interested in the
position and has decided this before the interview. A recruiting
specialist persuades the candidate to interview for the position
and to “just listen to what he has to say,” referring to the
executive vice president (EVP) conducting the interview. The
nurse reluctantly agrees to the interview and surprisingly leaves
with a positive view of the position and the potential for
change at this hospital, because the EVP sincerely and effec-
tively conveyed his vision to change the status quo and the
culture of the hospital. The candidate buys into his vision,
accepts the position, and works with the EVP to improve
care for their patients. The EVP in this scenario is an example
of a leader whose social skills allowed him to relay a
motivating vision.
To further develop their social skills, nurse leaders should
begin to build relationships with colleagues outside their
direct sphere of influence and, in interactions, seek to find
common ground where there may not initially be agree-
ment.1,22 Consider a scenario in which a surgical technologist
expresses concern regarding her upcoming performance
appraisal to a nurse leader who has been the administrator of a
surgery center for only a few months. The surgical technol-
ogist feels that the administrator has not worked with her
long enough to provide an accurate appraisal. They agree that
the technologist will complete a self-appraisal, the adminis-
trator will review it, and then they will sit together to com-
plete her final appraisal. The appraisal process takes several
hours of negotiation because the technologist believes she is
an excellent performer in every area; however, the adminis-
trator has constructive feedback to share. Although this takes
quite a bit of time for the leader, it is time well-invested as
they begin to understand one another and work toward
common goals. They build a rapport that improves their
working relationship.
Nurse leaders should resolve areas of potential and actual
conflict by addressing issues promptly using their social skills.
Building relationships with team members and those beyond a
nurse leader’s direct scope of responsibility could result in
increased EQ, which could affect staff retention2 and satis-
faction,4 along with increased job performance.3
TRAINING TO DEVELOP AND MAINTAIN
EQ SKILLS
Formal training is one way to develop and maintain EQ skills
in a team environment. This should begin with leadership
training that includes the elements of EQ. Leaders should
complete an honest self-evaluation followed by implementation
of learning strategies to increase their EQ. Staff members may
then participate in training in a similar manner. Depending on
which EQ assessment tools that leaders and staff members use,
the time commitment to complete a self-evaluation can range
from 10 to 45 minutes.10 The focus and content of formal
training programs may vary. For example, EQ training
programs may focus on achievement motivation, self-
management, interpersonal skill development, stress

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Beydler
management, or emotional competence and may target
different occupational groups, such as supervisors or hourly
workers.23 The Consortium for Research on Emotional
Intelligence in Organizations offers examples of programs that
have been shown to increase the EQ of adults in the
workplace.23
Training methods vary in the literature but may include a
combination of self-reflection and didactic and skills-based
training.24 Length of training reported in the literature
ranges from several hours to two years, and the optimal
training time to increase EQ requires additional research.24
One 2016 study found a significant improvement in the
self-reported EQ of nurses who attended two-hour training
sessions for six consecutive weeks.25 Two-hour repeated
(eg, quarterly) training may be appropriate in the periop-
erative environment to minimize staffing problems related
to removing nurses from the OR for long periods of time.
As an example of the potential cost commitment, Table 2
provides cost estimates for the wage commitment required
for staff RNs, managers, and directors to participate in
two-hour, quarterly training sessions for the first year
of training.
CONCLUSION
Emotional intelligence can be acquired and improved; it may
affect how well nurses will perform in the work environment
and how well they relate to those around them. Emotional
intelligence can be honed over time to provide greater success
and build stronger teams.1,11 Perioperative leadership in the
current health care environment requires both technical
competence and highly developed EQ skills. These skills are
associated with increased staff retention5 of the most skilled
and valuable employees in the organization. Effective leaders
should always seek to improve their own leadership style and
the performance of their team. Improved EQ effectiveness for
perioperative teams begins with an understanding of the


elements of EQ and includes personal assessment and ongoing
training.1,14,15,22
References
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Selected Writings. Northampton, MA: More Than Sound LLC;
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2. Bulmer Smith K, Profetto-McGrath J, Cummings GG. Emotional
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3. O’Boyle EH Jr, Humphrey RH, Pollack JM, Hawver TH, Story PA.
The relation between emotional intelligence and job performance:
a meta-analysis. J Organ Behav. 2011;32(5):788-818.
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4. Ngirande H, Timothy HT. The relationship between leader
emotional intelligence and employee job satisfaction. Mediterr
J Soc Sci. 2014;5(6):35-40.
5. Miao C, Humphrey RH, Qian S. A meta-analysis of emotional
intelligence and work attitudes. J Occup Organ Psychol. 2017;
90(2):177-202.
6. Weng HC, Hung CM, Liu YT, et al. Associations between emotional
intelligence and doctor burnout, job satisfaction and patient
satisfaction. Med Educ. 2011;45(8):835-842.
7. G€orgens-Ekermans G, Brand T. Emotional intelligence as a
moderator in the stresseburnout relationship: a questionnaire
study on nurses. J Clin Nurs. 2012;21(15-16):2275-2285.
8. McClelland D. Testing for competence rather than for “intelligence.”
Am Psychol 1973;28(1):1-14.
9. Musselwhite C. Self awareness and the effective leader. Inc. http://
www.inc.com/resources/leadership/articles/20071001/musselwhite
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10. Emotional intelligence measures. Consortium for Research on
Emotional Intelligence in Organizations. http://www.eiconsortium
.org/measures/measures.html. Accessed July 20, 2017.
11. Goleman D. How to be emotionally intelligent. New York Times.
April 7, 2015:ED17. http://www.nytimes.com/2015/04/12/education/
edlife/how-to-be-emotionally-intelligent.html?_r¼0. Accessed July 20,
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12. Freshman B, Rubino L. Emotional intelligence: a core competency
for health care administrators. Health Care Manag (Frederick).
2002;20(4):1-9.
13. Dye CF. Leadership in Healthcare: Values at the Top. Chicago, IL:
Health Administration Press; 2000.
14. Leadership & Communication in the Perioperative Setting: The
Impact on Patient Safety. Pfiedler Enterprises. http://www.pfiedler
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.pdf. Published 2013. Accessed July 20, 2017.
15. McKee A. If you can’t empathize with your employees, you’d better
learn to. Harvard Business Review. https://hbr.org/2016/11/if
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21. Kain Z. Breaking down silos with the perioperative surgical home.
Patient Safety & Quality Healthcare. http://www.psqh.com/analysis/
breaking-down-silos-with-the-perioperative-surgical-home. Published
April 3, 2015. Accessed July 20, 2017.
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Kathy Williams Beydler, MBA, RN, CNOR, Certified
Administrator Surgery Center (CASC), is the managing
partner at Strategic Surgical Solutions, Eads, TN. Ms
Beydler has no declared affiliation that could be
perceived as posing a potential conflict of interest in
the publication of this article.

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