Monday, 14 May 2018

Reply to Hoeltzell

Reply to: 

Austyn Snowden, PhD, RMN, FHEA

Thank you for commenting on our article, and for the opportunity to respond. To recap, our study found that there was a very small but positive correlation between ‘trait’ emotional intelligence and successful completion of a nursing degree at first attempt (Snowden et al., 2017). This was the finding from a three-year longitudinal study of a large cohort of Scottish student nurses who started training in 2013, and qualified in 2016. We also found that older females were more likely to complete the course, and that previous caring experience made absolutely no difference to whether students were successful or not, and in fact made it more likely for them to fail in year 1. 

We also found a slightly stronger correlation between ‘social connection’ and completion. Social connection was a factor we found in the Trait Emotional Intelligence Questionnaire- short form (TEIQue-SF) (Snowden et al., 2015), the questionnaire we used to measure trait EI in the study (Cooper and Petrides, 2010). ‘Social connection’ seemed to measure the ability to make connections between people, to apply EI. My interpretation is that it is this application of emotional intelligence that Ms Hoeltzell is referring to when arguing for ‘emotional competence’, the ability to express emotional intelligence in a social context. I’m not sure, but if my interpretation is correct, then we agree with her, because that’s what our research found.

However, I found the more interesting element of Ms Hoeltzell’s response to be the identification of emotional intelligence as ‘buzzword’. I couldn’t agree more with that. I think we have probably passed peak emotional intelligence, possibly even peak resilience, hence the need for related but extended concepts such as emotional competence. To me these less rigorous concepts simply signal that it’s time to move on, or at least look elsewhere. Our most recent data showed that in their first year of being qualified nurses, sickness/absence was associated with work experience, such that those with higher job satisfaction were less likely to go off sick. A bit obvious really, but still worth obtaining empirically. The relevant point to this response was that there was no relationship between emotional intelligence and sickness rates, or between resilience and sickness rates. Perhaps it’s time to stop blaming ourselves for lacking perfect personal attributes and instead consider a more practical analysis of the relationship between nurses and their work.

UK nursing has been through an unprecedented period of navel gazing as a consequence of care failings. Whilst it was right to reflect and repair, I think we have probably reached the end of the ‘attribute adventure’, and so I would personally consign emotional competence to history if I could, along with EI, compassion, and resilience. Instead, I would invite the social psychologists to have a go. John Paley’s critique of the compassion agenda (2013) was too early in the grief process for most to take at the time. I would urge another look.


Cooper, A., Petrides, K. V, 2010. A psychometric analysis of the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) using item response theory. J. Pers. Assess. 92, 449–57. doi:10.1080/00223891.2010.497426

Paley, J., 2013. Social psychology and the compassion deficit. Nurse Educ. Today 33, 10–11. doi:10.1016/j.nedt.2013.05.011

Snowden, A., Stenhouse, R., Marshall, S., Duers, L., Brown, N., Carver, F., Young, J., 2017. The relationship between emotional intelligence, previous caring experience, and successful completion of a pre-registration nursing/midwifery degree. J. Adv. Nurs. early view. doi:10.1111/jan.13455

Snowden, A., Watson, R., Stenhouse, R., Hale, C., 2015. Factor and Rasch Analysis of the Trait Emotional Intelligence Questionnaire Short Form. J. Adv. Nurs. 71, 2936–2949. doi:10.1111/jan.12746

Thursday, 10 May 2018

Commentary: Emotional Intelligence or Emotional Competency?

Commentary on: Snowden, A., Stenhouse, R., Duers, L., Marshall, S., Carver, F., Brown, N., & young, J. (2018). The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registered nursing/midwifery degree. Journal of Advanced Nursing, 74(2), 433-442. doi: 10.1111/jan.13455

Deborah Hoeltzell, BSN, BFA, RN, CCRN, CPAN, CNRN

I was pleased to have read the article from the February 2018 edition, “The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registration of a nursing/midwifery degree”. Currently, emotional intelligence and emotional competence are the buzz-words for nursing management, leadership, and educators. The authors in-depth study correlated emotional intelligence with successful completion in nursing studies. The subject is valid for the competitive heath care field. Considering emotional intelligence as a trait, and in the “nature versus nurture” debate on traits and competency, would it not be more logical to base importance upon emotional competency, rather than intelligence? According to Na, Wilkinson, Karny, Blackstone, & Stifter (2016) emotional competency compromises skills, such as emotional self-efficacy, inter-relational communication, identifying other’s emotions, awareness of one’s emotions, and capacities for empathetic and sympathetic involvement. These are a few factors to be considered for future nurse candidates.

Including these skills as nursing competencies can provide a refined dimension to an educational curriculum. Whether the potential nursing student has a high or low emotional intelligence would not be a deterrent to completion of a nursing degree. Today’s nurse must be self-aware and equipped with skills to maintain emotional well-being.


Snowden, A., Stenhouse, R., Duers, L., Marshall, S., Carver, F., Brown, N., & young, J. (2018). The relationship between emotional intelligence, previous caring experience and successful completion of a pre-registered nursing/midwifery degree. Journal of Advanced Nursing, 74(2), 433-442. doi: 10.1111/jan.13455

Na, J. Y., Wilkinson, K., Karny, M., Blackstone, S., & Stifter, C. (2016). A synthesis of relevant literature on the development of emotional competence: Implications for design of augmentative and alternative communication systems. American Journal of Speech-Language Pathology, 25, 441-452. doi: 10.1044/2016_AJSLP-14-0124

Thursday, 3 May 2018

Brexit: identity counts more than economics

Niall McCrae

A widely reported pattern in the referendum that decided that Britain would leave the EU was the yawning gap between young and old, with educational level and socio-economic status also important factors. Students are more likely to be pro-EU because a high proportion are young, relatively well-educated and middle-class.  Indeed, in a Brexit survey reported in a forthcoming edition of the Journal of Advanced Nursing, 80.5% voted Remain. 

The survey was a joint undertaking: me, a Leave voter concerned with sovereignty, and Professor Jonathan Portes, a leading economist who is sceptical about the economic benefits of Brexit. As well as our different disciplines, our disparate perspectives enhanced the partnership and hopefully dispels any suspicion of bias either way. We wanted to explore attitudes and motives for students’ views on the EU, the referendum verdict and prospects for Britain. Our 19-item Attitudes for Brexit Questionnaire was tested on the current population of pre-registration nursing and midwifery students at King’s College London.

Analysing the data from 162 respondents, we were struck by the prominence of values in the forming of opinion. Part of the instrument asked respondents to give three words that symbolised the EU and Brexit to them. For the EU, economic benefits were a long way behind terms that expressed virtue, such as ’tolerance’ and ‘inclusiveness’ (the smaller number of negatives included ‘controlling’ and ‘undemocratic’).  Similarly, the economy was scarcely mentioned in words symbolising Brexit.  Against a minority offering positives such as ‘independence’, the majority chose terms that were highly critical of Leave voters: ‘xenophobia’, ‘divisive’, ‘backwardness’ and ‘stupidity’.

A serious schism has emerged in British society. Older, socially conservative people value nationhood and cannot understand the younger generations’ attraction to what they see as a foreign bureaucracy. Younger people think of themselves as global citizens, and find the idea of English or white British identity excluding. Such a divide was conceptualised in David Goodhart’s The Road to Somewhere. The ‘Anywheres’ (up to a quarter of population) dominate our culture and much of the political establishment, as well as universities, the public sector and most professions. They are doing well in life, tending to live in metropolitan, multicultural areas.  When I mentioned prime minister Theresa May’s disdain for ‘citizens of nowhere’ in a lecture, a student responded: ‘No, we’re citizens of everywhere’. The ‘Somewheres’ are more numerous (about half of the population) and are more rooted in provincial or cultural identity (which may include communities black or Asian ethnicity, who normally vote for Labour but are not necessarily Europhile). They may not be rich financially, but have strong community bonds, enjoying the simpler things in life such as the local pub. 

It is a remarkable phenomenon that identity politics is so prevalent in the student and graduate ranks, while one major aspect of identity is disparaged. Nationhood is potentially the most inclusive of all, yet it is seen by many of our respondents as problematic if not racist. For the rift in society to heal, Remainers must stop seeing Leavers as xenophobes, and Leavers must desist from calling Remainers ‘traitors’.  In our sample, derogatory comments were almost entirely from Remain voters; the minority of Brexit supporters did not express doubts about the morality or intelligence of those favouring EU membership. 

The four-to-one majority for Remain is not inherently a problem, although it differs markedly from the national referendum result. However, group-think on major topics can have the effect of quelling debate in university, leaving assumptions unchallenged. Brexit is quite evidently divisive, but many of our respondents associated all Leave voters with racism, rather than reserving such assertions for campaigners who overtly expressed hostility to uncontrolled immigration. This is itself a divisive stance against compatriots (including, perhaps unwittingly, a fifth of their peers). Somehow society should facilitate discussion on complexities such as Britishness, eschewing simplistic dichotomies of right and wrong thinking. Extremists, by definition, do not represent the many.

The referendum has signalled the danger of failing to nurture a positive national identity (arguably, our education system and cultural influences do the opposite). People don’t want a jingoistic imperialist revival, but an inclusive sense of belonging and opportunity. The EU is a well-intended enterprise, but the nation state has a long pedigree as the means to preserve liberty, rights and welfare. The National Health Service, for example – far from perfect, but a demonstration of what a democratic country can achieve with the will of the people.   Although my co-author would argue that this depends on economic security…

Niall McCrae
King's College London, UK

Sunday, 15 April 2018

Duty rosters - how far ahead should they be made up?

Roger Watson, Editor-in-Chief

When I was a Charge Nurse, the job I hated most was making up the staff roster. You could never please everyone and, of course, if you were making it up then you certainly could not be seen to be pleasing yourself. Planning ahead was vital, but plan too far ahead and then staff had no flexibility; plan to close to the time when the roster was needed and you had less flexibility as staff requests were too numerous. How far ahead is enough and when is the optimum time to plan rosters, especially as staff may then simply take the time off as sick-time anyway and then you are short of staff or have to employ short-term staff to cover?

This article by from the UK by Drake (2018) titled: 'Does longer roster lead‐time reduce temporary staff usage? A regression analysis of e‐rostering data from 77 hospital units' was based on a study the aim of which was to investigate: 'whether longer roster lead-times reduce temporary staff usage.' Over 9 months nearly 700 rosters were examined from 77 hospitals in England. The effect of late roster approvals may contribute to nearly 40% of the use of temporary staff and longer approval time of 4-6 weeks reduced this to 15%. The complexities of the relationship are explained in the article.

The authors conclude: 'Between 2–4 weeks, roster lead-time is inversely proportional to temporary staff usage and reflects the assumed relationship between these two variables. However, beyond 4 weeks’ lead-time, the relationship enters a “plateau” phase where longer lead-time has negligible effect on staffing. At this stage, other factors, such as sickness, absenteeism, type of unit and patient demand pattern, define the lower limit of temporary staff usage. Consequently, this research implies that the optimum approval lead-time lies between 4–6 weeks.

You can listen to this as a podcast


Drake, R. G. (2018), Does longer roster lead‐time reduce temporary staff usage? A regression analysis of e‐rostering data from 77 hospital units. J Adv Nurs. doi:10.1111/jan.13578

Saturday, 7 April 2018

Menopause and sexual health

Roger Watson, Editor-in-Chief

Menopause is an inevitable feature of ageing in women who live long enough to experience it. Is is accompanied by age induced hormonal changes in the female reproductive tract which indicate the imminent end of fertility and is accompanied in many women with a period - sometime lasting years - of unpleasant side-effects. The most notable and visible of of these being 'hot flushes'. In any population of women the menopause has an impact on sexuality, this is known from research mainly involving western women. But what do we know about this in a relatively sexually conservative society such as the Cantonese Chinese population?

The study described here by Wong et al. (2108) was conducted in Hong Kong and and article titled: 'The Impact of Menopause on the Sexual Health of Chinese Cantonese Women: A Mixed Methods Study' was published recently in JAN. The study explored 'the impact of menopause on sexual health and marital relationships, the associated factors and the support needed among middle-aged and older women' and involved a sample of over 500 women who completed a questionnaire and 30 of whom were interviewed.

There was a high prevalence of sexual dysfunction and this was associated with depression. The effect on the women's sexual lives was negative and the most commonly reported effects of menopause were low sexual drive and vaginal dryness. As one woman said, more specific information about sex, in addition to the other aspects of menopause, needs to be provided: “I think it (information) should be more focused on sexual life. Because there is a lot of other information already. . . like there are videos about hot flashes, etc.. . . But not much about sex for both partners.”

In conclusion the authors say: 'This study gave a context for healthcare workers to better understand the challenges and needs of middle-aged and menopausal women and to ensure the provision of appropriate management of menopause in both clinical and community settings, targeting the family unit instead of women only. Better knowledge of the menopausal transition will enable healthcare service providers to implement appropriate programmes, education and services for different target populations.

You can listen to this as a podcast


Wong, E. L., Huang, F. , Cheung, A. W. and Wong, C. K. (2018), The Impact of Menopause on the Sexual Health of Chinese Cantonese Women: A Mixed Methods Study. J Adv Nurs. doi:10.1111/jan.13568