The effect of emotional intelligence on nurses’ job performance: the mediating role of moral intelligence and occupational stress

Nurses who are more involved in patient care and possess suitable job characteristics along with positive organizational factors are expected to perform their tasks better [1]. Improving healthcare performance remains a prominent global agenda, accounting for a significant portion of public health promotion costs worldwide. Continuous improvement of nurses’ job performance depends on various factors such as In-service Training and emotional intelligence [2].

Emotional intelligence is defined as “the capacity to recognize our own emotions and those of others,” allowing us to monitor and manage our emotions and relationships with others [3]. Numerous studies have demonstrated the positive impact of emotional intelligence on nurses’ job performance [4, 5]. Emotional intelligence is an integral part of an individual’s life and plays a crucial role in understanding their motivations, managing immediate impulses, empathizing with others, and utilizing emotions in thinking and perception. Emotional intelligence can direct people’s life paths and help them adapt to new situations [6]. Considering these characteristics, emotional intelligence is highly compatible with the nursing profession and facilitates functional job performance through its influence on task identity, skill variety, autonomy, task significance, and feedback [2].

Moral intelligence is one of the most important factors for developing emotional intelligence [7]. Based on Rogers’ approach, moral intelligence in nursing is defined as the “cognitive and value-based capability of a nurse in managing the process of problem-solving and conflict resolution through self-sacrifice and conscious participation in intrapersonal and interpersonal relationships“ [8]. Moral intelligence is an essential acquired ability in nursing that is closely linked to emotions and reason, which leads to responsible decision-making and behavior by balancing thoughts and feelings [9, 10]. Ethical behavior arising from moral intelligence depends on the integration of emotions, intuition, and reasoning [11]. Despite ethical challenges in nursing practice, nurses often remain attuned to the outcomes of care interventions. Their performance is grounded in humanistic values, and the quality of care they provide depends heavily on their adherence to ethical standards. Therefore, ethical and clinical performances are intrinsically linked [12]. Research has indicated that moral intelligence can be cultivated through education and is essential for effective nursing performance in domains such as “personal-professional development,” “holistic care delivery,” and “managing stress” and stress management [13].

Occupational stress can stem from various sources and can affect individuals in different ways. A demanding work schedule, working with complex equipment, intricate power and skill hierarchies, expectations, demands, and high mortality rates cause healthcare workers to experience high-stress levels [14]. Consequently, both negative and positive correlations may be observed between occupational stress and performance [12]. While stress generally has a negative image, a balanced level of stress is necessary for optimal task performance; without stress, individuals may not exert the necessary effort to complete tasks. In other words, prolonged or excessive stress gradually leads to physical and mental exhaustion, eventually resulting in decreased energy [15]. Several studies have indicated that employees’ ability to utilize emotions and influence the feelings of other staff members directly reduces physical and psychological stress in the workplace [8, 16]. Rafiee et al. (2013) found that occupational stress can influence job performance quality by affecting both emotional intelligence and moral intelligence [17].

Since job performance of nurses impacts the hospital’s performance excellence [18], evaluating the factors that influence this performance is crucial. Previous studies confirmed the positive influence of emotional intelligence on nurses’ job performance [2, 19]. However, the mediating roles of moral intelligence and occupational stress in this relationship remain unclear. This study aims to fill this gap by examining how these factors mediate the link between emotional intelligence and job performance.

This descriptive, cross-sectional, correlational study was conducted from February to April 2022 in healthcare centers affiliated with Urmia University of Medical Sciences. The sample size was determined using a 1:5 ratio, indicating that five samples were collected for each item of the questionnaire. Four questionnaires were used and 122 items were answered by the participants. A sample size of 610 was calculated as the minimum requirement; however, 671 participants were ultimately recruited to account for potential attrition. Quota sampling was used, with the total number of nurses in the study population (N = 2347) divided by the desired sample size (n = 671), yielding a ratio of 0.2858. This ratio was then multiplied by the number of nurses in each hospital to determine allocation (Fig. 1). Eligible participants had at least one year of work experience, completed the questionnaires honestly, and dedicated adequate time to the task. Incomplete questionnaires with over 5% missing data were excluded.

Approval for the study was granted by the Research Ethics Committee, and nurses’ contact information was obtained through nursing management offices. Participants were informed of the study’s objective and assured of confidentiality and their right to withdraw at any time. Consent forms and questionnaires were provided either online or in person depending on the participants’ preferences. Those completing the questionnaire online were given 48 h to answer, while participants receiving the questionnaire in person were given 72 h. If the questionnaires were not returned within the specified time, the participants were given another 48 h. Nurses who refused to complete the questionnaire were excluded from this study. Of the 671 questionnaires distributed, 621 were completed and returned.

Of the 671 questionnaires distributed, 621 were completed, resulting in a response rate of 88.7%. Participants had a mean age of 33.55 ± 8.49 years and an average work experience of 9.36 ± 7.93 years. Regarding marital status, 364 participants (59.7%) were married, whereas 246 (40.3%) were single. The sex distribution included 225 males (36.9%) and 385 females (63.1%). Regarding educational level, 505 participants (82.8%) held bachelor’s degrees, 90 (14.8%) had master’s degrees, and 15 (2.4%) had doctoral degrees. The employment status was diverse: 151 nurses (24.8%) were under mandatory workforce contracts, 37 (6.1%) were company employees, 90 (14.8%) were contract staff, 76 (12.5%) were on probation, and 256 (42%) were permanent employees. Regarding family size, 124 participants (20.3%) had one child and 165 (27%) had two or more children.

The results showed that Cronbach’s alpha values obtained for emotional intelligence (0.72), occupational stress (0.95), moral intelligence (0.95), and job performance (0.92) indicated good internal reliability for the model (Table 1). The discriminant validity of the model was confirmed using the Fornell-Larcker criterion (Table 2).

The conceptual model is examined by testing the hypotheses. The results are detailed in two sections, covering path coefficients (β) and t-values, with the findings illustrated in Fig. 2; Table 3.

The path coefficients (β) quantify the direct impact of one construct on another. A β-value exceeding 0.6 indicates a strong predictive relationship; values between 0.3 and 0.6 represent moderate effects, while values below 0.3 suggest weak effects. The analysis indicated that emotional intelligence had a weak but positive effect on job performance (β = 0.099). The effect of emotional intelligence on moral intelligence was weak and negative (β = -0.257). Additionally, moral intelligence had a negative but moderate impact on job performance (β = -0.562). Emotional intelligence has a moderate negative effect on occupational stress (β = -0.316). Occupational stress has a weak but positive impact on job performance (β = 0.084). Moral intelligence exhibits a weak positive effect on occupational stress (β = 0.145). The t-values for the relationships between variables exceed the critical value of 1.96, indicating with at least a 95% confidence interval that these connections are statistically significant (Fig. 2) (Table 3).

The bootstrap analysis results revealed that the upper and lower bounds of the confidence intervals for the indirect relationship between emotional intelligence and job performance through moral intelligence did not include zero, confirming the significance of this mediating path. Conversely, the upper and lower bounds of the confidence interval for the indirect relationship between emotional intelligence and job performance through occupational stress included zero, indicating that this pathway was not significant. Additionally, the mediating role of moral intelligence in the relationship between emotional intelligence and occupational stress was confirmed as the confidence intervals excluded zero (Table 4).

The hypothetical model included 16 observed variables and four latent variables: occupational stress, job performance, emotional intelligence, and moral intelligence. The goodness-of-fit indices for the measurement model were satisfactory (RMSEA = 0.053, NFI = 0.92, NNFI = 0.95, PNFI = 0.91, CFI = 0.94, IFI = 0.94, RFI = 0.91).

This study aimed to investigate the impact of emotional intelligence on job performance, focusing on the mediating effects of moral intelligence and occupational stress among nurses.

Our findings suggest that emotional intelligence has a positive but minor effect on nurses’ job performance. Higher emotional intelligence can improve patient care and job performance, likely due to better nurse collaboration [3, 57]. Numerous studies have confirmed a positive relationship between emotional intelligence and job performance, probably because nurses view emotional intelligence as a vital innate and acquired skill. Emotional intelligence enhances patient care, fosters empathy, strengthens nurses’ roles as patient advocates, builds interpersonal relationships, and aids in emotional regulation. This, in turn, guides clinical decision-making and promotes professionalism. These factors are essential for the quality of job performance in nursing [3, 6].

However, some studies have indicated that the effect of emotional intelligence on job performance can be neutral or even negative. These studies attributed this to emotional labor, in which nurses suppress negative emotions to meet service standards and regulations. While this may improve service quality and ensure patient satisfaction, it can also result in emotional fatigue, occupational stress, and burnout [58, 59].

Our study found that moral intelligence indirectly and positively mediates the effect of emotional intelligence on job performance. Lennick found that the principles of moral intelligence facilitate emotional well-being and self-awareness [60]. Similarly, Hagerman et al. (2020) reported that compassion, a key element of moral intelligence, enhances job performance and increases emotional intelligence in nursing students [61]. Consequently, high moral intelligence aids in organizing values, promoting intelligent and efficient actions, enhancing emotional intelligence, and improving cognitive adaptability to new situations, all of which contribute to improved job performance [8, 62]. In contrast to our findings, previous research showed no positive association between emotional intelligence, moral intelligence, and job performance, suggesting that emotional intelligence has a minimal influence on emotional regulation in situations involving ethical dilemmas, such as medical errors, death, or pandemics. In such scenarios, nurses may struggle to maintain consistent job performance and ethical behaviors may be suppressed to meet minimum performance standards [7]. A logical justification for this contradictory finding is that an ethical dilemma creates intense feelings that pull the decision-makers in opposite directions, making it difficult to choose between more moral and less ethical options. This inner conflict is even stronger when negative emotions are evoked since such emotions may affect a person’s choices and actions to a great extent. With higher negative emotions, it was found that decisions were less ethical [63].

Additionally, our results showed that moral intelligence mediated the relationship between emotional intelligence and occupational stress. As nurses gain more exposure to clinical environments, their emotional intelligence levels increase [64], and the roots of altruism and professional responsibility are strengthened. This emphasis on ethical behavior in clinical settings, supported by moral intelligence, helps nurses manage environmental challenges and cope with occupational stress [30]. Areshtanab (2021) found that students with high levels of moral intelligence, emotional intelligence, and spiritual intelligence had greater resilience, which reduced work stress and errors [65]. Nurses who experience decent working conditions have improved psychological well-being, enhanced vigor, better job stress management, and a greater inclination to embrace a moral ideology [66, 67].

In other words, high job demands and low control in the clinical setting contribute to occupational stress. However, moral intelligence enhances personal qualities, enabling nurses to assess colleagues, regulate frustration, and neutralize impulsive reactions by influencing emotional intelligence [58]. Nurses with higher moral intelligence—demonstrating responsibility, empathy, integrity, and forgiveness—are generally better equipped to physically, emotionally, and mentally handle unpredictable situations in care environments. Preparedness improves the quality of patient care [68]. Nonetheless, Raisi et al. (2018) found that high moral intelligence had less influence on managing aggression in medical and nursing students, which they attributed to the stressful and high-pressure nature of the clinical environment. The insufficient support and the lack of “safety-moral intelligence” were identified as potential reasons for the limited effectiveness of moral intelligence in these contexts [69].

Finally, our structural model does not confirm occupational stress as a mediator between emotional intelligence and job performance. This may be because emotional intelligence serves as a control mechanism for stress. Whether individuals use emotional intelligence to manage stress and improve job performance depends on their personal choices. Individuals with higher emotional intelligence can more effectively overcome environmental challenges. At the same time, those who find it difficult to regulate their emotions may rely on ineffective coping strategies, such as defense mechanisms. This may explain why occupational stress does not mediate the relationship between emotional intelligence and job performance. In the model presented by Jalees et al. (2021), occupational stress negatively impacted job performance, with emotional intelligence acting as a moderator. Similarly, our findings align with their structural model, which rejected occupational stress as a mediator [58].

The alignment between these studies likely stems from how individuals respond to stress, which depends largely on personality traits and emotional intelligence levels. Our study may have yielded different results because we did not account for personality traits [70]. According to the Job-Demand Resources Model and a study by Newton et al. (2016), high emotional intelligence leads to a better understanding of stressors (e.g., managerial conflicts, workload) that inhibit employees from achieving performance-related goals [44, 45]. Our study concluded that occupational stress does not buffer the relationship between job performance and emotional intelligence. However, a contrasting study reported that defense mechanisms, such as stress avoidance, emotional labor, and mental health preservation, may be triggered in critical situations, such as understaffing or increased patient load. These mechanisms suppress emotional intelligence, rendering it incompatible with the environment [3]. Cultural and personality factors heavily influenced this outcome. Ultimately, choosing emotional intelligence as a coping strategy can mitigate the negative effects of stressors by enhancing an individual’s understanding of their environment and the consequences of stress on job performance [44].

This study confirms that emotional intelligence has a direct and positive impact on job performance, with moral intelligence acting as mediators, enhancing the impact of emotional intelligence and thereby improving job performance. Therefore, implementation of personal development programs focused on strengthening emotional intelligence and self-regulation among nurses is recommended.

Moral and emotional intelligence should be prioritized as crucial criteria when selecting nursing staff and management personnel. Healthcare organizations can create a safe and low-stress environment that significantly improves nurses’ job performance and overall well-being. Healthcare managers play a pivotal role in this development by promoting nurses’ emotional intelligence. They can achieve this by offering comprehensive and practical courses to cultivate critical skills such as self-awareness, self-management, social awareness, and relationship management. These courses will empower nurses to better understand their emotions, regulate their responses, empathize with patients and colleagues, and build strong professional relationships.

In parallel, nurturing moral intelligence within the nursing workforce is essential. This can be accomplished by organizing educational programs focusing on vital attributes such as integrity, responsibility, compassion, and forgiveness. By equipping nurses with these moral skills, healthcare facilities can promote a culture of ethical practice and support that benefits the staff and enhances the quality of patient care.