THE ROLE OF EMOTIONAL INTELLIGENCE ON DECREASING JOB

1 Running head: EMOTIONAL INTELLIGENCE

THE ROLE OF EMOTIONAL INTELLIGENCE ON DECREASING JOB STRESS AND

BURNOUT AND INCREASING PROFESSIONAL FULFILLMENT AMONG

CERTIFIED REGISTERED NURSE ANESTHETISTS WORKING IN A HOSPITAL

SETTING

by

Meredith Szyikowski

A DNP project submitted to the

School of Nursing

State University of New York

in partial fulfilment of the requirements of the degree of Doctor of Nursing Practice

December 2019

2 EMOTIONAL INTELLIGENCE


Table of Contents

Abstract…………………………………………………………………………………………...4

Introduction……………………………………………………………………………………….6

Background and Significance…………………………………………………………………….7

Research Question……………………………………………………………………………….10

Limitations……………………………………………………………………………………….21

Recommendations and Future Research…………………………………………………………22

Appendix B………………………………………………………………………………………27

Appendix C………………………………………………………………………………………28

Appendix D………………………………………………………………………………………31

Appendix E………………………………………………………………………………………34

Acknowledgements……………………………………………………………………………… 5

DNP Essentials…………………………………………………………………………………..10

Review of Literature……………………………………………………………………………..11

Theoretical Framework…………………………………………………………………………..14

Methods and Design……………………………………………………………………………..16

Cultural and Ethical Considerations……………………………………………………………..17

Data and Analysis………………………………………………………………………………..19

Results…………………………………………………………………………………………...19

Discussion………………………………………………………………………………………..21

References………………………………………………………………………………………..23

Appendix A……………………………………………………………………………………....26

IRB Approval Form……………………………………………………………………………...35

https://Limitations.21

https://Question.10


Abstract

Background and Significance: Nurse anesthesia is a stressful career path that demands

providers to be cognizant of the physical and emotional needs of themselves, their patients, and

their fellow colleagues. Stress not only contributes to adverse health issues, it also contributes to

job stress, burnout, and turnover.

Purpose and Objective: The purpose of this Doctor of Nursing Practice (DNP) project was to

examine the baseline level of EI among CRNA’s working within a Western New York (WNY)

hospital organization to study the correlation between EI and job burnout and fulfilment.

Theoretical Framework: Sister Calista Roy’s Adaptation Model

Methods and Design: Approximately 50 CRNAs employed with an anesthesia group in a WNY

hospital organization were invited to voluntarily participate in this project via email. A

demographic survey and two questionnaires, the Stanford Professional Fulfillment Inventory and

the Hay 360 EI Quiz, were utilized to collect data.

Results: An ANOVA analysis was performed through SPSS 25. The results indicated that there

is not a significant relationship between EI and job burnout or fulfilment levels. Statistical

significance of (p<.039) was found when correlating educational level to the Hay 360. This

showed that Doctorate level CRNAs have less EI than CRNAs of other educational backgrounds.

Future Implications: Results could provide the foundation for projects exploring EI educational

interventions for CRNAs, Student Registered Nurse Anesthetists (SRNAs), and other healthcare

providers.

Keywords: Emotional Intelligence, Nurses, Nurse Anesthetists, Job Stress, Job Burnout,

Healthcare providers


Acknowledgements

Thank you to everyone that has supported me throughout this academic process. To my mother,

father, and two sisters, I could not have done this without your constant love and encouragement.

To my niece and goddaughter, the worst of the days were made better with your smile. And to

my dog Roark, thank you for the always necessary therapeutic cuddles.

Thank you to Dr. Faust, Dr. Sessanna, Dr. Spulecki, and Dr. Bittenger for supporting this project.

I appreciate all of your knowledge and encouragement. Thank you to all the amazing CRNA’s

that have precepted me. I have learned from each and every one of you.


Certified Registered Nurse Anesthetists (CRNAs) need to have the ability to handle a

multitude of tasks that center on the delivery of safe patient care while the surgeon provides

quality services under optimal conditions. Not only do CRNAs need leadership, communication,

and collaboration skills, they also need to be emotionally in tune with themselves and with the

emotional needs of those surrounding them. According to Chipas and Mckenna (2011), the

profession is recognized as highly stressful because CRNAs often experience financial

constraints, decreased self-esteem from having to change jobs, strains on personal relationships

due to decreased time for self and others, and stress from starting school in an unfamiliar

location requiring a move.

It is important for CRNAs to be able to multitask with positive attitudes and efficient

time management skills. In a study conducted by Boyd and Poghosyan (2011), CRNAs reported

that 48% of their daily stress levels was attributed to their careers. Study findings additionally

revealed that Student Registered Nurse Anesthetists (SRNAs) reported that 90% of their daily

stress stemmed from their anesthesia education (Boyd & Poghosyan, 2011). Given the complex

demands placed on CRNAs and the intensive training required to become a CRNA, educational

institutions with CRNA programs select candidates who possess ability to succeed in challenging

and rigorous CRNA programs (American Association of Nurse Anesthetists [AANA], 2019).

CRNA educational programs, as well as continuing education activities in healthcare

organizations, need to develop training methods for CRNAs and other health care providers that

enhance emotional management skills through emotional intelligence (EI) education.

While CRNA educational programs provide SRNAs with knowledge on providing

anesthesia for a wide range of patients, most programs do not provide education on the role of EI

in the practice of nurse anesthesia. Emotional intelligence education has not been implemented


within the SRNA/CRNA population and therefore the potential benefits have not been studied.

Through understanding the complexities of different roles found within the operating room

setting and the emotional underpinnings of each role, EI can enhance the nurse anesthetist’s

ability to become a more knowledgeable and well-rounded provider by promoting effective

communication with colleagues and patients, safer patient care, decreased stress and burnout

levels, and increased leadership skills (Collins, Covrig, & Newman, 2014).

Background and Significance

Various definitions of EI exist since the original definition of EI was presented by

Salovey and Mayer in the 1990s (Stein & Howard, 2006). Salovey and Mayer defined EI as “the

ability to perceive emotions, to access and generate emotions so to assist thought, to understand

emotions and emotional meanings, and to reflectively regulate emotions in ways that promote

emotional and intellectual growth” (Stein & Howard, 2006, p.13).

Recognition of the important role EI plays in various professions has grown and this

increased interest has led to its application in a host of different areas across the world, spanning

various cultures and languages. Within the United States (US), EI education has started in

several states that mandate inclusion of EI into the curriculum (Goleman, 2019). Evidence has

suggested that by incorporating social and emotional learning into classroom settings, children

can learn how to identify their own emotions as well as the emotions of others. As they get older,

these children will have the skills to manage their emotions which can lead to decreased

violence, enhanced culture within schools, improved academic success, and the ability to manage

various challenges that they may face (Nathanson, Rivers, Flynn, & Brackett, 2015).

Considering the benefits of EI in primary education, the application of EI education in

graduate level curriculum warrants further exploration. SRNAs are held to a high academic


standard while undergoing a significant amount of stress. By embedding the constructs of EI into

the curriculum, SRNA’s may be better prepared to manage their stress levels making them more

successful in their academic careers and potentially less vulnerable to burnout as they transition

to their professional careers. A study by Codier, Kooker, and Shoultz (2008) found a positive

correlation between clinical performance levels and EI scores among nurses. By providing

SRNA’s with EI education, SRNAs have opportunity to gain valuable skills that may help them

decrease their stress levels resulting in improved academic performance and clinical standing as

well as having opportunity to increase their level of job satisfaction upon entrance into the

workforce. Additionally, EI education can provide SRNA’s with the ability to read the emotions

of those around them including patients, colleagues, and surgeons. This has the potential to lead

to increased communication and leadership skills which may lead to better patient care and

increased patient satisfaction.

EI has been utilized in the business world for years. The components of EI are believed to

help enhance leadership roles, relationships between colleagues, and stress management

capabilities (Stein & Book, 2006). With EI education continuing to establish credibility,

instituting its value into nurse anesthesia curriculum should be explored. A study by Celik (2017)

found that patient satisfaction scores were significantly correlated with higher EI levels among

nurses. While many studies exist exploring EI in healthcare, little research currently exists

exploring the impact of EI education among CRNAs and SRNAs. This gap in the literature

supports the need for further research exploring the role of EI in among SRNAs and CRNAs and

the impact of EI on job burnout and stress.


Purpose, Aims, and Objectives

The purpose of this Doctor of Nursing Practice (DNP) project was to examine the

baseline level of EI among CRNA’s working within a Western New York (WNY) hospital

organization to determine if a correlation exists between EI and job burnout and stress. The aim

of this DNP project was to increase understanding regarding the role of EI among CRNAs in

decreasing stress and burnout and improving job satisfaction and how EI may help SRNAs and

CRNAs successfully navigate through their careers and educational programs. Project objectives

were to 1) evaluate job burnout and professional fulfillment among CRNAs working at the

project site via the Stanford Professional Fulfillment Index (SPFI) survey; 2) assess the

importance of EI and its applicability in developing a successful career among CRNAs working

at the project site via the Hay 360 EI Quiz; 3) to report project findings back to the CRNAs

working at the project site during a unit meeting so that the CRNAs can determine if EI

development is something they wish to incorporate into their skill set; and 4) to develop

recommendations based on project findings for including EI content into the University at

Buffalo (UB) CRNA program curriculum. Gaining this information could provide educational

institutions with insight regarding whether the inclusion of EI education into CRNA curriculum

would be prudent. If increased levels of EI are correlated with increased job satisfaction and

patient satisfaction, as well as decreased stress levels, this could indicate that EI should be

included in nurse anesthesia curriculums.

DNP Essentials

The American Association of Colleges of Nursing’s (AACN, 2006) DNP Essentials

provide the foundation for graduate nursing curriculum and support the overall goal of advancing

nursing professionalism and education. DNP Essential I, Scientific Underpinnings for Practice


(translating scholarship into practice) and DNP Essential II, Organizational and Systems

Leadership for Quality Improvement and Systems Thinking (focusing on EI and the role it may

play among CRNAs) are addressed throughout this project since the purpose of the project is to

explore how to promote increased leadership skills, improved communication, decreased stress

levels, and increased job satisfaction among CRNAs. A review of the literature on EI provided

insight regarding how EI may impact CRNA practice and patient care and how to promote the

development of new CRNA practice (AACN, 2006). Scholarship and research, important

components of the DNP Essentials, require the ability to look outside of the healthcare field for

evidence that may align with the goals of providing best care. Better patient outcomes is an

important goal in healthcare but is not always easily reached. Human beings are very complex

and require more than just physical care. Studying the impact of EI among CRNAs may benefit

patients, providers, and healthcare institutions by exploring what is needed to educate SRNAs

while still in training so that they are able to practice these skills as they practice technical skills

as CRNAs.

Review of the Literature

A review of literature was conducted to explore the role of EI among CRNAs, SRNAs,

and in the healthcare field in general. A thorough search was performed using the following

databases: EBSCO, MEDLINE, and Google Scholar. Keywords utilized in the search included

emotional intelligence, EI, nurses, nurse anesthetists, students, healthcare providers, stress,

burnout, and job satisfaction. Articles were included in the review that were published within the

past five years and in the English language. The literature search revealed that although many

studies have been published focusing on EI in nursing and healthcare fields, a limited number of

studies have been published on the role of EI among CRNAs and the correlation with stress


levels and burnout. The studies reviewed supported the significance of the role of EI in health-

related fields and provided evidence as to why further studies are necessary.

Job Stress and Burnout

Samaei et al. (2017) discovered that EI has an inverse relationship with job stress and

burnout. The authors found that as EI levels increased, levels of burnout decreased. The authors

concluded that EI education should be considered for nurses. This cross sectional study was

performed in three hospital within Iran and included 300 nurses with the objective to find out the

relationship between EI and job stress. Two surveys were distributed to assess levels of job stress

and burnout, both of which were tested for validity. The nurses were also given an EI

questionnaire that was tested for reliability and validity. The results were statistically significant

(P <0.001), showing that EI has a negative relationship with stress levels.

A study performed by Szczygiel and Mikoajczak (2018) examined the relationship

between EI and its impact on negative emotions that affect job burnout. The study included 188

nurses from three hospitals in Poland. The authors concluded that while negative emotions do

not always lead to burnout, nurses with lower levels of EI and negative emotions were more

likely to report burnout (P <0.01). The authors stressed the importance and significance of EI

education on the overall wellbeing of nurses, on the impact of financial savings to healthcare

institutions, on decreasing levels of turnover, on increasing patient safety, and on increasing job

satisfaction. The authors also maintained that EI can provide nurses with methods on how to

cope with situations that are demanding and distressing.

Juardo, Perez-Fuentes, Ruiz, Marquez, and Linares (2019) conducted a study that

included 1777 nurses in Spain. The authors utilized a web-based platform where three surveys

were distributed that assessed perceived stress, general self-efficacy (a person’s own perception


of how they handle stressful situations), and EI. The results showed a strong negative

relationship between EI and stress. The authors differentiated between gender and EI and how,

in the Spanish population, it may be beneficial to have different educational courses based on

gender.

Hong and Lee (2016) studied the effects of EI on emotional labor, job stress, burnout and

nurse’s turnover intention in South Korea. This study utilized questionnaires that were

distributed to 240 nurses with a total of 211 eligible for analysis. The results showed that job

stress and burnout were the first and second factors for turnover intention. EI had a significant

indirect effect on turnover intention because it had an effect on both job stress and burnout. The

results also found that EI mediates emotional labor and burnout. The authors suggested that

introducing programs to increase the EI of nurses would potentially decrease the rate of nurse

turnover.

EI and Conscientiousness

While many studies found positive correlations with EI and overall job performance and

satisfaction indicating benefits for healthcare systems, a study by Vandewaa, Turnipseed, and

Cain (2016) found that the value of EI has been overrated. This study utilized the concept of EI

developed by Salovey and Mayer and the organization citizenship behavior tool developed by

Organ. Organization citizenship behavior describes traits and behaviors that are found to be

desirable to an organization and include altruism and generalized compliance. One subset of this

is conscientiousness which involves coming to work on time and rarely missing work. For this

subset, the study found that higher levels of EI were linked with higher levels of

conscientiousness but a subset called sportsmanship was not supported by EI. The authors

concluding that EI is not globally helpful for healthcare organizations. Sportsmanship


encompasses the ability of an individual to not complain and air grievances. This study provided

more evidence as to why further research needs to be done considering the benefits of EI.

Different designs and outcomes need to be considered in order to have a more comprehensive

bank of information on EI in healthcare.

A review of the literature revealed that although many studies supported the positive

benefits of EI among the nurses, doubt remains regarding EI education and its true impact in the

nursing profession. EI can be difficult to define and measure which leads researchers to doubt

how well it can be assessed. Gaps in the literature also exist exploring EI among nurse

anesthetists who have different job descriptions and stressors. This DNP project aims to gather

information on the current status of EI among CRNAs working in a hospital system to support

whether EI educational interventions are warranted.

Theoretical Framework

The BarOn Model of EI contains the following five divisions that make up the concept of

EI: intrapersonal, interpersonal, adaptability, stress management, and the general mood realm

(Stein & Book, 2006). Because EI focuses on the ability to recognize the emotions within oneself

as well as others, and how this recognition can be utilized to shape a given situation, Roy’s

Adaptation Model was chosen as the theoretical framework because it supports the five divisions

found in the BarOn Model of EI. This framework supports the study of EI because its

components work in congruence with the components of the Roy’s Adaptation Model. The

model focuses on how a person is in constant interaction within an ever changing environment

and how the goal of nursing is to successfully adapt to the changes (Masters, 2015).

Roy’s definition of adaption coincides with EI which relies on the ability of an individual

to assess their own feelings and emotions as well as the emotions of others to consciously create


an environment of health and wellbeing (Masters, 2015). Roy’s Adaptation Model also focuses

on the innate characteristics of an individual as well as what is acquired through experience and

education. This is what Roy refers to as the regulator and cognator subsystems which describes

how a person will react chemically and automatically to a situation, as well as how someone

emotionally responds with processing and judging a situation (Masters, 2015, p. 129). These two

subsystems result in certain behaviors that allow the individual to cope. EI can build off of this

theory because of its ability to educate the individual to adapt and control the situation through

the use of interpersonal and intrapersonal skills that can provide a more conducive environment

for themselves and others. Roy’s definition of the environment, conditions affecting the

behaviors of the person, is useful in the study of EI because EI speaks to how individuals need to

be aware of how their own emotions and the emotions of others may be different despite being

introduced to the same circumstances and how these differing emotions may affect the ability to

adapt as well as the outcomes of a given situation (Masters, 2015).

One very important scientific assumption of Roy’s Adaptation Model in relation to EI is

that “thinking and feeling mediate human action” (Masters, 2015, p. 134). Healthcare is more

than taking care of a patient physically. It is becoming more and more important to pay attention

to the mental health of patients which means being aware of patient perceptions and emotional

reactions to their circumstances surrounding their conditions. Healthcare providers need to be

aware of their own emotions as well and how what they think and feel effects their everyday

lives and those around them, especially those under their care. Roy’s Adaptation Model marries

the concepts of EI with its own and provides the theoretical foundation for the continuing study

of EI in healthcare and why more research and attention needs to be paid to enhancing the

education of all providers. Although many studies have focused on the benefits of increased EI


among providers in terms of patient care, more research is needed to determine how EI affects

the providers themselves in terms of job satisfaction and stress levels. The question remains

whether or not providers are adapting to their new environments as Roy’s Model of Adaptation

states is needed for the wellbeing of the individual and group. Knowing that EI education has

many studied benefits, it is time to close the gap of knowledge regarding how EI may affect

CRNA’s levels of stress and burnout.

Methods and Design

The study design incorporated a three survey email distribution and quantitative methods

for analysis including descriptive statistics and a one-way ANOVA using SPSS 25. A between

group and within group analysis was conducted with the guidance of a quantitative methods

expert on faculty in the UB School of Nursing. Study recruitment included flyers that were

placed in break and conference rooms at the hospitals (Appendix A). A list of CRNA emails

were obtained with permission from the hospital administrative staff. An initial email invitation

requesting study participation was then sent out to approximately 50 CRNA’s working within the

WNY hospital organization (Appendix B). The email invitation explained to potential

participants the purpose and objectives of the study, information regarding volunteer consent to

participate, participant rights to withdraw from the study at any point in time without penalty,

and the right not to answer any survey question. Consent was obtained through completion and

submission of the surveys. Demographic information was obtained to gain background

information regarding age, sex, ethnicity, years in profession, educational background, and

marital status (Appendix E). Two surveys were distributed, the Stanford Professional Fulfillment

Inventory (SPFI) (Appendix C) and the Hay 360 Emotional Competence Inventory (Hay 360 EI

Quiz) (Appendix D). The SPFI has been validated and is available online for free which added to


its reason for use. The Hay 360 EI Quiz was utilized to provide insight into the baseline EI of the

CRNA’s. Participants had to be greater than 18 years old and had to hold current certification as

a CRNA.

Human Rights and Ethical Considerations

This study was low risk to the target participants. The study utilized online surveys that

were anonymous and utilized methods for deidentification. The facilities selected for this study

have a reciprocal Institutional Review Board (IRB) agreement with UB’s IRB. Participants were

informed that they may withdraw from the study at any time without fear of recourse.

Participation was completely voluntary and did not target any special populations or pose a risk

to participant’s health. Ethical considerations were addressed by keeping the surveys and

responses anonymous and deidentified. All data collected will be kept on a password protected

laptop and will only be accessed by those on the DNP project team. Data will be stored as per the

UB IRB protocol and will be retained for a period of three years then destroyed.

Tools

The SPFI is a 16-question survey that evaluates job burnout as well as professional

fulfillment (Appendix C). This tool was developed as an alternative to the Maslach Burnout

Inventory. It measures three components regarding work exhaustion, professional fulfillment,

and interpersonal disengagement (Trockel et al., 2018). While this was studied using physicians,

the measurements can be expanded to include other providers including CRNAs. This tool was

developed to assess how interventions effect these parameters. This tool also aids in another

contribution by assessing professional fulfillment as well.

In their development of the tool, Trockel et al. (2018) assessed how their tool correlated

to other measures of burnout such as the Maslach Burnout Inventory (MBI) Survey. While the


MBI has been used for many years, it was felt that it did not readily capture all components of

burnout and that it lacked both positive and negative phrasing in its tool which may have

compromised its assessment capabilities (Trockel et al., 2018). The SPFI attempted to reconcile

these shortcomings by changing its language to incorporate both positive and negative questions

as well as by addressing well-being. The survey also utilizes time frames so that if an

intervention is introduced, whether short or long term, the survey can capture its effects by

assessing the feelings of the survey responder within the previous two weeks (Trockel et al.,

2018).

Despite the recent development of this tool, the authors were able to establish reliability

by a test-retest strategy to establish the stability of the tool over time. Validity was acknowledged

throughout the article but the analysis was not readily available and can be accessed by request

only (Trockel et al., 2018). The DNP project student has contacted the creator of the tool for

permission of use and the results of the validity analysis.

The Hay 360 EI quiz assesses EI (Appendix D) and were used for this study as it is less

time consuming and free to use. This tool is also utilized in EI workshops held at the UB system

to help train participants in EI and leadership skills. It consists of a 10 item questionnaire that

provides answers and rationales to develop an understanding of the importance of EI and its

applicability in developing a successful career. This tool was utilized by Gorgas, Greenberger,

Bahner, and Way (2015) to assess an EI intervention in emergency medicine residents using a

pre and post-test type design. In studying CRNA’s, this tool was used to gain a baseline level of

EI. The results were compared with the survey on burnout to determine if there were correlations

between level of EI and level of job burnout. Because this tool is a sample of a larger tool, it

only gives a basic synopsis of a participant’s EI and cannot be considered to have the same


validity and reliability of the parent assessment tool. However, future testing could potentially

provide more insight into the validity and reliability of the sample tool. This tool was chosen in

part because other assessment tools are considerably longer and would require CRNA’s attention

for much longer. This was a concern for recruitment in participation and completion of the study.

The demographic survey (Appendix E) included gender, age, ethnicity, level of education

completed, population served, years in CRNA profession, children in household, and marital

status.

Data Analysis and Results

After cleaning data in SPSS, descriptive statistics were completed as well as an ANOVA

correlating HAY 360 scores with the SPFI tool. Of the approximately 50 CRNAs that received

the email, 15 CRNA’s participated by completing the survey. Of these 15 responders, 10 were

female and 5 were male. The largest age group represented was 31-35 with 40% of responders

falling into this range. 25-30, 41-45, 51-55 ranges each represented 13.3% of the responders and

36-40, 56-60, 61-65 representing 6.7% each. 80% of respondents reported having Caucasian or

white ethnicity with 13.3% describing themselves as Hispanic or Latino and 6.7% reporting

Asian or Asian American. 73.3% of respondents reported being currently married with never

married and widowed each representing 6.7% and divorced representing 13.3% of respondents.

73.3% of participants reported having children in the household with 26.7% reporting zero

children within household. Respondents were also asked to report years in practice. The 0-5 year

group was represented the most with 53.3% respondents. The 11-20 year group was second with

20%, followed by 13.3% participants selecting 6-10 years and 21-30 and 31+, each representing

6.7%. The educational background of the participants showed that 80% of respondents reported

having a masters degree followed by 13.3% reporting a doctorate degree, and 6.7% selecting


other. There were not any CRNAs that selected pediatrics as the only population served. 53.3%

of participants selected that they serve both populations while 46.7% reporting that they serve

adults only.

The SPFI tool was broken into two sections as the first section assesses job fulfilment and

the second assess job burnout. Scores greater to or equal to 18 indicate job fulfilment. In the

second section scores greater than or equal to 14 indicate burnout. The median and mean for

SPFI fulfilment was 16, with a range of 3-23. The mean and median for SPFI burnout was 11,

with a range of 4-11. SPSS showed that the majority of CRNAs do not feel job fulfillment with

66.7% of scores coming in below 18. However, 33.5% indicated that they are burned out. The

data continued to support that higher EI scores correlated with lower fulfilment, displaying a

negative relationship. Higher EI scores also correlated with higher burnout levels, displaying a

positive relationship.

The Hay 360 quiz works on a scale of 0-100. Higher scores are correlated with higher EI.

The range of scores were from 45 to 85 with the median score being 65 and mean 65.33.

Doctorate prepared CRNAs showed the lowest EI while the respondent of “other” for

educational background received the highest score, indicating high EI.

A one way between subjects ANOVA was conducted to compare the effect of EI on job

fulfillment and job burnout among CRNAs in a WNY healthcare organization. There was not a

significant effect of baseline EI on job fulfillment and burnout. However, there was a significant

effect of educational preparation on EI levels at the p <.05 level [F (2,12) = 4.297, p = .039].

This indicates that higher levels of education are associated with decreased levels of EI within

this population.


Discussion

CRNA’s are responsible for up to 49 million anesthetics in the US each year (AANA,

2019). Many of these anesthetics are in collaboration with physician anesthesiologists, surgeons,

or other healthcare providers such as podiatrists and dentists. Due to the increasing need for safe

patient care, it is important that CRNA’s are provided with all the tools necessary to provide the

best care possible. While CRNA’s go through rigorous training both academically and clinically,

the addition of emotional care for both the CRNA and the patient has not been incorporated as

much as it could be. EI helps bridge that gap in care that extends past the physical need and helps

encompass the emotional needs as well.

This study did not provide statistical significance to the potential benefits of EI in the

WNY community of CRNAs. These results indicated that CRNAs have a negative relationship

with EI and job fulfilment. CRNAs with higher EI scores showed lower levels of fulfilment.

33.3% of respondents scored around 18 indicating job fulfilment on the SPFI. However, 33.3%

of respondents were considered having burnout with scores about 14 on the SPFI. These scores

were also correlated with increased levels of EI. While these results were not expected, the role

of EI within the CRNA population still deserves further exploration.

Strengths and Limitations

While this study received a 25% response rate (N=15), it was limited by using the

western NY population of CRNAs within a local health organization. This means that the results

may not be generalized to the rest of the CRNA population across the country. However, a

strength of this project is that it could easily be introduced among other CRNA providers in a

variety of locations. This study received IRB exempt status and did not present any potential

harm to respondents, making it easy to implement in a variety of settings.


EI assessment tools are typically lengthy, at times exceeding 100 questions. When

considering EI assessment options for this study, the decision was made to find a tool that would

not dissuade potential respondents. The Hay 360 Quiz, is a tool utilized by UB in training

sessions for employees. This tool is only ten questions and was chosen due to its widespread use

within the university as well as its shorter length that would hopefully entice potential subjects to

participate.

Future Implications

This study is one of the first that provides insight into the relationship between EI and

CRNAs and the impact EI has on job satisfaction and burnout. As more knowledge is gained on

this subject, more studies may be developed that further investigate the emotional aspects of

providers. This author recommends that this study is performed in additional groups of CRNAs

in various geographical locations. This study could also be performed in SRNAs using another

tool to gauge stress levels. An additional suggestion would be to use a more comprehensive EI

assessment tool along with incentives for CRNAs to complete them due to their length and time

requirements.

Conclusion

Despite lacking statistical significance regarding EI in the CRNA population, additional

studies need to be done to determine the full scope that EI may have on the nurse anesthesia

provider. EI has the potential to be a beneficial tool in the healthcare industry and as more

studies are performed EI may find an important role in the education of future CRNAs as well as

CRNAs in practice.


References

American Association Colleges of Nursing. (2006). The essentials of doctoral education for

advanced nursing practice. Retrieved from

http://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf

American Association of Nurse Anesthetists (2019). Certified registered nurse anesthetists fact

sheet. Become a CRNA. Retrieved from https://www.aana.com/membership/become-a-

crna/crna-fact-sheet

American Association of Nurse Anesthetists. (2019). What potential students need to know about

nurse anesthesia educational program interview process. Become a CRNA. Retrieved

from https://www.aana.com/membership/become-a-crna/the-nurse-anesthesia-

educational-program-interview-processb

Boyd, D., & Poghosyan, L. (2017). Certified registered nurse anesthetist working conditions and

outcomes: A review of the literature. American Association of Nurse Anesthetists, 85(4),

261-269.

Celik, G.O. (2017). The relationship between patient satisfaction and emotional intelligence

skills of nurses working in surgical clinics. Patient Preference and Adherence,11,1363-

1368, doi: 10.2146/PPA.S136185

Chipas, A., & McKenna, D. (2011). Stress and burnout in nurse anesthesia. American

Association of Nurse Anesthesia, 79 (22), 122-128.

Codier, E., Kooker, B.M., Shoultz, J. (2008). Measuring the emotional intelligence of clinical

staff nurses: An approach for improving the clinical care environment. Nursing

Administration Quarterly, 32(1), 8-14.

https://www.aana.com/membership/become-a-crna/the-nurse-anesthesia

https://www.aana.com/membership/become-a

http://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf


Collins, S.B., Dovrig, D., & Newman, I. (2014). Q-factor emotional intelligence profiles as an

area for development in graduate nurse anesthesia students. Journal of Nursing

Education, 53(9), 501-510. doi: 10.3928/01484834-210140821-13

Emotional Intelligence. (n.d.). Emotional intelligence – Daniel Goleman. Retrieved from

http://www.danielgoleman.info/topics/emotional-

intelligence/

Gorgas, D.L., Greenberger, S., Bahner, D.P., & Way, D.P. (2015). Teaching emotional

intelligence: A control group study of a brief educational intervention for emergency

medicine residents. Western Journal of Emergency Medicine, 16(6), 899-906.

Halbesleben, J.R.B., & Demerouti, E. (2005). The construct validity of an alternative measure of

burnout: Investigating the English translation of the Oldenburg Burnout Inventory. Work

and Stress, 19(3), 208-220.

Hong, E., & Lee, Y.S. (2016). The mediating effect of emotional intelligence between emotional

labour, job stress, burnout, and nurses’ turnover retention. International Journal of

Nursing Practice, 22(6), 625-632.

Juardo, M. M. M., Perez-Fuentes, M. C., Ruiz, N. F. O., Marquez, M. M. S., Linares, J. J. G.

(2019). Self-efficacy and emotional intelligence as predictors of perceived stress in

nursing professionals. Medicina, 55(237). doi: 10.3390/medicina55060237

Masters, K. (2015). Nursing theories: A framework for professional practice. Retrieved from

https://www.jblearning.com/catalog/productdetails/9781284048353

Nathanson, L., Rivers, S.E., Flynn, L.M., & Brackett, M.A. (2016). Creating emotional

intelligent schools with RULER. Emotion Review, 8(4), 1-6.

https://www.jblearning.com/catalog/productdetails/9781284048353

http://www.danielgoleman.info/topics/emotional


Samaei, S. E., Khosravi, Y., Heravizadeh, O., Ahangar, H. G., Pourshariati, F., & Amrollahi, M.

(2017). The effect of emotional intelligence and job stress on burnout: A structural

equation model among hospital nurses. International Journal of Occupational Hygiene,

9(2), 52-59.

Stein, S. J., & Book, H. E. (2006). The EQ edge: Emotional intelligence and your success.

Mississauga, ON: Jossey-Bass.

Szczygiel, D.D., & Mikolajczak, M. (2018). Emotional intelligence buffers the effects of

negative emotions on job burnout in nursing. Frontiers in Psychology, 9(2649). doi:

10.3389/fpsyg.2018.02649

Trockel, M., Bohman, B., Lesure, E., Hamidi, M.S., Welle, D., Roberts, L., & Shanafelt, T.

(2018). A brief instrument to assess both burnout and professional fulfillment in

physicians: Reliability and validity, including correlation with self-reported medical

errors, in a sample of resident and practicing physicians. Academic Psychiatry, 42(1), 11-

24. doi: https://doi.org/10.1007/s40596-017-0849-3

Vandewaa, E. A., Turnipseed, D. L., & Cain, G. (2016). Panacea or placebo? An evaluation of

the value of emotional intelligence in healthcare workers. Journal of Health and Human

Services Administration, 38(4), 438-477.

https://doi.org/10.1007/s40596-017-0849-3


Appendix A

CRNA Recruitment Flier



Appendix B

CRNA Email Project Invitation


Dear Certified Registered Nurse Anesthetists,

I am a third year University at Buffalo student registered nurse anesthetist. I am

performing a study that will assess the impact of emotional intelligence on job fulfilment,

burnout, and stress in the CRNA population employed at Kaleida Health institutions. This is not

only a topic that I am interested in but is necessary for the completion of my doctorate degree.

I am asking that you take three surveys that are completely anonymous. One is to obtain basic

demographic information, another assesses emotional intelligence, and the third measures job

fulfilment as well as burnout. These surveys should not take longer than 20 minutes total and

are completely anonymous. The links are provided below and may be completed at your

leisure. Your participation is completely voluntary and you may decide not to complete the

surveys if you wish. Your consent to participate is implied by your completion of the surveys. If

you have any questions or concerns, please feel free to contact me. I appreciate your

consideration as well as your time.

Warmly, Meredith Szyikowski [email protected]

<links to survey monkey applied here>

mailto:[email protected]


Appendix C

Stanford Professional Fulfillment Index


How true do you feel the following statements are about you at work during the past two weeks?

Very Not at all Somewhat Moderately Completely

true true true true True

Score=0 Score=1 Score=2 Score=4 Score=3

a. I feel happy at work [ ] [ ] [ ] [ ] [ ]

b. I feel worthwhile at work [ ] [ ] [ ] [ ] [ ]

c. My work is satisfying to me [ ] [ ] [ ] [ ] [ ]

d. I feel in control when dealing

with difficult problems at work [ ] [ ] [ ] [ ] [ ]

e. My work is meaningful to me [ ] [ ] [ ] [ ] [ ]

f. I’m contributing professionally

(e.g. patient care, teaching,

research, and leadership) in the [ ] [ ] [ ] [ ] [ ]

ways I value most

Table 2.

To what degree have you experienced the following?

Not at Very Moderately A lot Extremely

all little During the past two weeks I have felt…

Score=2 Score=3 Score=4 Score=0 Score=1

a. A sense of dread when I think about [ ] [ ] [ ] [ ] [ ]

work I have to do

b. Physically exhausted at work [ ] [ ] [ ] [ ] [ ]

c. Lacking in enthusiasm at work [ ] [ ] [ ] [ ] [ ]

d. Emotionally exhausted at work [ ] [ ] [ ] [ ] [ ]

Not at Very Moderately A lot Extremely

During the past two weeks my job has all little

contributed to me feeling… Score=2 Score=3 Score=4

Score=0 Score=1

a. Less empathetic with my patients [ ] [ ] [ ] [ ] [ ]

b. Less empathetic with my colleagues [ ] [ ] [ ] [ ] [ ]

c. Less sensitive to others’ [ ] [ ] [ ] [ ] [ ]

feelings/emotions

d. Less interested in talking with my [ ] [ ] [ ] [ ] [ ]

patients

e. Less connected with my patients [ ] [ ] [ ] [ ] [ ]


f. Less connected with my colleagues [ ] [ ] [ ] [ ] [ ]


Appendix D

The Hay 360 EI Quiz


Directions: Answer the following questions to get a glimpse into your own experiences at work

and their impact on your effectiveness.

1. You are on an airplane that suddenly hits extremely bad turbulence and begins rocking

from side to side. What do you do?

1. a) Continue to read your book or magazine, or watch the movie, trying to pay

little attention to the turbulence. [10]

2. b) Become vigilant for an emergency, carefully monitoring the stewardesses and

reading the emergency instructions card. [10]

3. c) A little of both a and b. [10]

4. d) Not sure - never noticed. [0]

2. You are in a meeting when a colleague takes credit for work that you have done. What do

you do?

1. a) Immediately and publicly confront the colleague over the ownership of your

work. [0]

2. b) After the meeting, take the colleague aside and tell her that you would

appreciate in the future that she credits you when speaking about your work. [5]

3. c) Nothing, it's not a good idea to embarrass colleagues in public. [0]

4. d) After the colleague speaks, publicly thank her for referencing your work and

give the group more specific detail about what you were trying to accomplish.

[10]

3. You are a customer service representative and have just gotten an extremely angry client

on the phone. What do you do?

1. a) Hang-up. It doesn't pay to take abuse from anyone. [0]

2. b) Listen to the client and rephrase what you gather he is feeling. [5]

3. c) Explain to the client that he is being unfair, that you are only trying to do your

job, and you would appreciate it if he wouldn't get in the way of this. [0]

4. d) Tell the client you understand how frustrating this must be for him, and offer a

specific thing you can do to help him get his problem resolved. [10]

4. You are a college student who had hoped to get an A in a course that was important for

your future career aspirations. You have just found out you got a C- on the midterm.

What do you do?

1. a) Sketch out a specific plan for ways to improve your grade and resolve to follow

through. [10]

2. b) Decide you do not have what it takes to make it in that career. [0]

3. c) Tell yourself it really doesn't matter how much you do in the course, concentrate

instead on other classes where your grades are higher. [5]

4. d) Go see the professor and try to talk her into giving you a better grade. [0]


$5. You are a manager in an organization that is trying to encourage respect for racial and ethnic

diversity. You overhear someone telling a racist joke. What do you do?

1. a) Ignore it - the best way to deal with these things is not to react. [0]

2. b) Call the person into your office and explain that their behavior is inappropriate and is

grounds for disciplinary action if repeated. [5]

3. c) Speak up on the spot, saying that such jokes are inappropriate and will not be tolerated

in your organization. [10]

4. d) Suggest to the person telling the joke he go through a diversity training program. [5]

6. You are an insurance salesman calling on prospective clients. You have left the last 15

clients empty-handed. What do you do?

1. a) Call it a day and go home early to miss rush-hour traffic. [0]

2. b) Try something new in the next call, and keep plugging away. [10]

3. c) List your strengths and weaknesses to identify what may be undermining your

ability to sell. [5]

4. d) Sharpen up your resume. [0]

7. You are trying to calm down a colleague who has worked herself into a fury because the

driver of another car has cut dangerously close in front of her. What do you do?

1. a) Tell her to forget about it-she's OK now and it is no big deal. [0]

2. b) Put on one of her favorite tapes and try to distract her. [0]

3. c) Join her in criticizing the other driver. [5]

4. d) Tell her about a time something like this happened to you, and how angry you

felt, until you saw the other driver was on the way to the hospital. [10]

8. A discussion between you and your partner has escalated into a shouting match. You are

both upset and in the heat of the argument, start making personal attacks which neither of

you really mean. What is the best thing to do?

1. a) Agree to take a 20-minute break before continuing the discussion. [10]

2. b) Go silent, regardless of what your partner says. [0]

3. c) Say you are sorry, and ask your partner to apologize too. [0]

4. d) Stop for a moment, collect your thoughts, then restate your side of the case as

precisely as possible. [0]

9. You have been given the task of managing a team that has been unable to come up with a

creative solution to a work problem. What is the first thing that you do?

1. a) Draw up an agenda, call a meeting and allot a specific period of time to discuss

each item. [0]


2. b) Organize an off-site meeting aimed specifically at encouraging the team to get

to know each other better. [10]

3. c) Begin by asking each person individually for ideas about how to solve the

problem. [0]

4. d) Start out with a brainstorming session, encouraging each person to say

whatever comes to mind, no matter how wild. [5]

10. You have recently been assigned a young manager in your team, and have noticed that he

appears to be unable to make the simplest of decisions without seeking advice from you.

What do you do?

1. a) Accept that he "does not have what it takes to succeed around here" and find

others in your team to take on his tasks. [0]

2. b) Get an HR manager to talk to him about where he sees his future in the

organization. [5]

3. c) Purposely give him lots of complex decisions to make so that he will become

more confident in the role. [0]

4. d) Engineer an ongoing series of challenging but manageable experiences for

him, and make yourself available to act as his mentor. [10]


Appendix E

Demographic Survey


Gender:

Male____ Female____ Other ____

Age:

25-30____ 31-35_____ 36-40_____ 41-45____ 46-50_____ 51-55_____ 56-60____

61-65____ 66-70_____ 71+____

Ethnicity:

Caucasian____ Black or African American ____ American Indian or Alaskan____

Asian____ Native Hawaiian or Pacific Islander____ Multiple Races_____ Other_____

Marital Status:

Married_____ Widowed_____ Divorced____ Separated_____ Never Married____

Children in Household:

Yes___ No____

Educational Background:

Masters_____ Doctorate_____

Population Specialty:

Adults____ Pediatrics____ Both___

Years in Practice:

0-5___ 6-10____11-20____21-30____30+____


Appendix F

University at Buffalo Institutional Review Board Confirmation


University at Buffalo Institutional Review Board (UBIRB)

Office of Research Compliance | Clinical and Translational Research Center Room 5018 875 Ellicott St. | Buffalo,

NY 14203

UB Federalwide Assurance ID#: FWA00008824

STUDY EXEMPTION

October 9, 2019

Dear Meredith Szyikowski,

On 10/9/2019, the University at Buffalo IRB reviewed the following submission:

Type of Review: Initial Study

Title of Study: The impact of baseline emotional intelligence in certified registered nurse

anesthetists on job stress and burnout

Investigator: Meredith Szyikowski

IRB ID: STUDY00003790

Funding: None

Grant ID: None

IND, IDE, or

HDE: None

Documents

Reviewed:

• DNP Poster.pdf, Category: Recruitment Materials; • DNP email.pdf,

Category: Recruitment Materials; • Scientific review form.pdf, Category:

Other;

• Consent Document.pdf, Category: Consent Form; • Demographic Survey.docx, Category: Surveys/Questionnaires;

• MSzyikowski4 HRP-503-Template Protocol.docx, Category: IRB Protocol;

• SPFI.docx, Category: Surveys/Questionnaires; • Hay 360 EI .docx, Category: Surveys/Questionnaires;

• DNP Follow up email.pdf, Category: Recruitment Materials;

The University at Buffalo Institutional Review Board has considered the submission for the

project referenced above on 10/9/2019 and determined it to be Exempt.

In conducting this study, you are required to follow the requirements listed in the Investigator

Manual (HRP-103), which can be found by navigating to the IRB Library within the Click

system.

UBIRB exemption is given with the understanding that the most recently approved procedures

will be followed and the most recently approved consenting documents will be used. If

modifications are needed that may change the exemption determination, please contact the UB


IRB Office. Also, see the Worksheet: Exempt Determination (HRP-312) for information on

exemption criteria and categories.

Page 1 of 2

University at Buffalo Institutional Review Board (UBIRB)

Office of Research Compliance | Clinical and Translational Research Center Room 5018 875 Ellicott St. | Buffalo,

NY 14203

UB Federalwide Assurance ID#: FWA00008824

As principal investigator for this study involving human participants, you have responsibilities to

the SUNY University at Buffalo IRB (UBIRB) as follows:

1. 2.

3. 4. 5. 6.

Ensuring that no subjects are enrolled prior to the IRB approval date.

Ensuring that the UBIRB is notified of:

• • All Reportable Information in accordance with the Reportable New

Information Smart Form.

• • Project closure/completion by submitting a Continuing

Review/Modification/Study Closure Smart Form in Click.

Ensuring that the protocol is followed as approved by UBIRB unless minor changes that

do not impact the exempt determination are made.

Ensuring that the study is conducted in compliance with all UBIRB decisions, conditions,

and requirements.

Bearing responsibility for all actions of the staff and sub-investigators with regard to the

protocol.

Bearing responsibility for securing any other required approvals before research begins.

If you [email protected].

have any questions, please contact the UBIRB at 716-888-4888 or ub

mailto:[email protected]







