Li et al. BMC Nursing (2021) 20:144 https://doi.org/10.1186/s12912-021-00658-4

RESEARCH Open Access Relationship between emotional intelligence and job well-being in Chinese clinical nurses: multiple mediating effects of empathy and communication satisfaction Xue Li1, Hongjuan Chang1*, Quanying Zhang2, Jianli Yang2, Rui Liu1 and Yajie Song1

Abstract Background: Nursing work is associated with great pressure, and nurses are often overwhelmed. Therefore, correct emotional regulation is essential to improve nurses’ job well-being and promote better engagement in nursing work. The purpose of this study was to establish a structural model to estimate the impact of Chinese clinical nurses’ emotional intelligence on job well-being, using multiple intermediaries to explain the internal mechanisms underlying the relationship. Methods: This was a cross-sectional study of 1475 registered nurses from a Chinese hospital who provided responses to emotional intelligence, empathy, communication satisfaction, and job well-being scales. Path analysis using a multiple mediation model was performed using AMOS 23.0. Results: Among all clinical nurses who participated in the survey, 1475 (98.33 %) completed the questionnaire. The nurses’ job well-being score was 83.61 ± 12.63. There was a significant positive correlation between job well-being and communication satisfaction, emotional intelligence, and empathy ability (r = 0.346–0.570, P < 0.001). Empathy and communication satisfaction partially mediated the relationship between emotional intelligence and job well- being, with effect sizes of 0.047 and 0.227, respectively. The chain mediating effect of empathy and communication satisfaction had a value of 0.045. Conclusions: It is recommended that hospital managers take actions to improve nurses’ emotional intelligence level, and conduct professional psychological training to improve nurses’ empathy and communication satisfaction, and ultimately improve their job well-being. Keywords: Clinical nurses, Emotional intelligence, Empathy, Communication satisfaction, Mediation

* Correspondence: [email protected] 1College of Nursing, Xinxiang Medical University, No.601 Jinsui Avenue, Hongqi District, Henan Province 453003 Xinxiang City, China Full list of author information is available at the end of the article

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Background process of communication, and to structure words and Since the 1950 s, positive psychology has increased in actions appropriately [16]. The concept of emotional prominence, and researchers have paid greater attention intelligence was first proposed by Mayer and Salovey to the study of people’s positive mental states, well-being (1990). Emotional intelligence is a comprehensive ability, and other related concepts [1]. Hoopert [2]definedwell- and the essence of improving emotional intelligence is a being as a positive mental state that includes competence, means by which to change emotional output [17]. The emotional stability, engagement, meaning, optimism, posi- nature of nursing work determines that nurses are highly tive emotions, positive relationships, resilience, self-esteem, emotional workers. Therefore, research on emotional and vitality. Job well-being denotes experiencing pleasant intelligence has gradually entered the field of nursing psychological states at work, which is conducive to the full [18]. Good emotional intelligence may help nurses development of personal potential and the realization of manage sources of situational stress, make better nursing work goals [3]. Research has revealed that a high level of decisions, reduce the effects of negative emotions, and job well-being has a positive impact on nurses’ work en- positively affect their provision of care, as well as their thusiasm, efficiency, and job satisfaction, while a low level physical and mental health [19]. Research has shown of job well-being results in problems such as work-related that emotional intelligence is an important predictor of exhaustion and increased conflict with patients [4]. In happiness, and individuals with a high level of emotional addition, lack of happiness at work is a major reason why intelligence can maintain a positive emotional state and nurses quit their jobs [5]. In Europe, 43 % of nurses con- a high level of happiness [20]. Therefore, we hypothesize sider leaving their job within three years [6]. In China, the following: healthcare is hindered by an average annual turnover rate of nurses of 28 %, and the country is facing a shortage of Hypothesis 1: Emotional intelligence will significantly nurses [7]. Increasing the happiness of nurses plays an im- predict job well-being (emotional intelligence → job portant role in stabilising the nursing team and improving well-being). the quality of nursing. In the context of the current global COVID-19 pandemic, the healthcare systems in many The mediating role of empathy between emotional countries are under severe pressure; with fewer nurses intelligence and job well-being attending more patients, nurses are facing tremendous In positive psychology, empathy refers to the ability of physical and psychological pressure. Research has indicated nurses to correctly perceive their own and their patients’ that nurses’ job well-being is related to factors such as high emotions from the perspective of the patient, so as to work pressure, work satisfaction, and poor organisational meet the physical needs of the patient and provide emo- management [8–10]. tional experiences that alleviate the psychological pain of Happiness-related research has rapidly developed since the patient [21]. Empathy enables medical staff to con- its inception. In its early stages, Chinese and international duct care from the perspective of the patient, respect the researchers usually assessed teachers, older persons, or patient, and ultimately enables the patient to receive ef- patients with psychological problems [11–13]. More re- fective nursing interventions [22]. When the patient feels cently, research on well-being has targeted healthcare understood and respected, he or she will be more willing workers. This is important to decrease the negative emo- to cooperate with the nursing staff during treatment and tions experienced by nurses and to thereby create a good better understand the nurses, which will, at the same working atmosphere, consequently reducing nurses’ job time, stimulate the nurse’s enthusiasm for work and im- burnout and leaving hospitals, and creating a harmonious prove his or her happiness. Therefore, we hypothesized nursing workforce [14]. The nurse-patient relationship is the following: of great significance. However, at present, domestic and foreign researches on happiness are mostly related to bi- Hypothesis 2: Emotional intelligence will influence variate research, and the potential relationship between job well-being through the mediating effect of variables is rarely reported [15]. Therefore, this study used empathy (emotional intelligence → empathy → job clinical nurses as the research object to explore the inter- well-being). action mechanism among the four variables of emotional intelligence, empathy, communication satisfaction, and The mediating effect of communication satisfaction job well-being, so as to provide references for intervention between emotional intelligence and job well-being research to improve nurses’ job well-being. Communication satisfaction refers to subjective feelings as to whether individuals are satisfied with all aspects of The influence of emotional intelligence on job well-being communication within an organisation [23]. Good com- Emotional intelligence in the context of nursing refers to munication skills are key to building a harmonious the ability to understand the patient’s emotions in the nurse-patient relationship, and a catalyst in motivating Li et al. BMC Nursing (2021) 20:144 Page 3 of 10

nurses to work. Nurses with strong communication Methods abilities also have good collegial relationships, enjoy Aims better moods, and a higher sense of self-efficacy than This study explored the current level of nurses’ job well- their counterparts [24]. Consequently, we hypothesize being, and whether empathy and communication satis- the following: faction mediate the relationship between emotional intelligence and job well-being. Hypothesis 3: Emotional intelligence will influence job well-being through the mediating effect of Design communication satisfaction (emotional intelligence The study adopted a descriptive cross-sectional design → communication satisfaction → job well-being). and adhered to the STROBE guideline for cross- sectional studies. The chain mediating effect of empathy and communication satisfaction on emotional intelligence and Participants job well-being A questionnaire survey was conducted among nurses in Only by correctly monitoring and recognising the emo- a tertiary general hospital in Henan Province from tions of patients can nurses realise empathy for their September to December 2019. A total of 1475 nurses patients [25]. Patient-centred and high-quality nursing participated in the study. A convenience sampling services are inseparable from active and effective com- method was used to select participants from each of the munication. Using empathy while communicating with 65 hospital departments, including internal medicine, patients is conducive to eliminating patients’ negative surgery, paediatrics, gynaecology, and intensive care emotions, reducing suffering from complications, achiev- units. The inclusion criteria were as follows: (1) participants ing ideal treatment results, improving patients’ satisfaction must have obtained a nursing certificate and had to be a with nurses, reducing the need for nursing care, and im- registered clinical nurse with a ‘Nurse Professional Qualifi- proving nurses’ job-related well-being. Consequently, we cation Certificate’, (2) they must have attended at least a proposed that empathy and communication satisfaction technical secondary school, and (3) volunteered to partici- would play a chain mediating role in the relationship be- pate in the survey and to provide accurate and reliable tween emotional intelligence and job-related well-being. answers. The exclusion criteria were: (1) non-hospital regis- tered on-the-job nurses, including intern nurses, non- Hypothesis 4: Empathy and communication satisfaction nursing staff, and nurses who came to visit and study in the willjointlyplayanintermediaryroleintherelationship hospital, (2) nurses who were on vacation, retired, or not between emotional intelligence and job well-being, working in the hospital during the questionnaire survey. (emotional intelligence → empathy → communication satisfaction → job well-being). Measurements Demographic characteristics Through searching and reviewing the relevant litera- A self-compiled general demographic questionnaire was ture, we found that hospital managers have only begun adopted, including the nurse’s age, gender, working years, to pay attention to nurses’ job well-being in recent years, education level, work department, average monthly and there is a lack of theoretical foundation for research income, type of contract, emotional intelligence related on job well-being in the nursing profession. At the same training, intensity of work, frequency of night shift, etc. time, most of the scales used by researchers to measure the level of job well-being are not aimed at nursing pro- Outcome variable: job well-being fessions, so the results are relatively inconsistent and The Job well-being Scale for Nurses, compiled by Chen cannot adequately reflect the general situation in a nurs- and Liu [26] was adopted to evaluate the subjective well- ing context. The job well-being measurement scale used being of nurses in work situations, including nurses’ in this research is specifically aimed at nurses, and it has positive emotion and cognitive evaluation of their work. a good general applicability in China. Job well-being The scale includes a total of 19 items, and 5 dimensions: is a comprehensive indicator that is affected by many “Welfare treatment”, “interpersonal”, “work value”, factors; this study explored the mechanisms under- “manager”, and “working characteristics”. All items were lying the relationship between job well-being and rated on a Likert scale, with “1” representing “strongly emotional intelligence, empathy, and communication disagree” and “6” representing “strongly agree”. The total satisfaction. Further, the current work suggests ways scores range from 19 to 114, and the higher the score, by which to effectively enhance nurses’ job well-being, the higher the nurses’ job well-being. The scale was valid improve job performance, and further advance high- and reliable with a Cronbach’s α coefficient of 0.929 in quality nursing services. this study. Li et al. BMC Nursing (2021) 20:144 Page 4 of 10

Independent variables: emotional intelligence on a departmental basis, using nurses’ morning meet- Wang and Law’s Emotional Intelligence Scale was ings, business studies, and after get off work. All nurses adopted to evaluate the level of emotional intelligence on the job who meet the inclusion criteria and are will- [27]. In this study, it was mainly used to evaluate the ing to participate in the survey will issue questionnaires. emotional intelligence level of nurses, that is, nurses’ The investigator informs the purpose of the study, and ability to distinguish and regulate their own emotions obtains the nurse’s informed consent, and reads out the from others, and to use emotional information to guide explanation instruction to guide the nurse to fill it out. thinking. The scale has a total of 16 items and 4 dimen- The questionnaire can be withdrawn at any time during sions: “self-emotional perception”, “emotion regulation”, the process and the questionnaire will be collected on “emotional use”, and “recognize other’s emotions”. All the spot. A total of 1,500 questionnaires were distributed items are rated on a Likert scale, with “1” standing for and 1,475 were recovered, with an effective rate of “strongly disagree” and “7” standing for “strongly agree”. 98.33 %. The higher the total score of the scale, the higher the emotional intelligence level of nurses. The scale was Ethical consideration valid and reliable with a Cronbach’s α coefficient of This study was approved by the local ethics committee 0.926 in this study. (number XYLL-2,018,096). Obtained permission from the hospital to issue research questionnaires and con- Mediator variable: empathy ducted anonymous surveys. All participants in the study Jefferson Empathy Scale was compiled by Dr. Hojat in are voluntary participation. 2001 [28]. Chinese scholar Xiuqin An [29] then trans- lated it into the Chinese version of JSE-HP scale, which Data analysis is used to measure the empathy ability of doctors, stu- SPSS (version 25.0) statistical software was used for stat- dents and nursing professionals. This study mainly used istical analysis. The data were normally distributed with- it to evaluate the nurse’s empathy ability, that is, the out outliers or missing values. Pearson correlation nurse’s ability to understand the patient’s inner experi- analysis was used to investigate the relationships among ence and opinions, and to convey this understanding to emotional intelligence, empathy, communication satis- the patient. The scale has a total of 20 items and 3 di- faction, and job well-being. Then, AMOS (version 21.0) mensions: “perspective taking”, “compassionate care”, was used to establish the structural equation model. and “standing in patient’s shoes”. All items were rated First, a model with emotional intelligence as the inde- on a Likert scale, with “1” meaning “completely agree”, pendent variable and job well-being as the dependent and 7 meaning “completely disagree”. The higher the variable was constructed to test Hypothesis 1. Second, score, the higher the level of empathy. The scale was two intermediary variables of empathy and communica- valid with a Cronbach’s α coefficient of 0.845 in this tion satisfaction were added between emotional study. intelligence and job well-being, and hypotheses 2 and 3 were tested. Finally, under the premise that the two- Mediator variable: communication satisfaction factor mediation model was established, the chain medi- The Interpersonal Communication Satisfaction Scale ation effect of Hypothesis 4 was tested to form the final was compiled by Hecht in 1978 [30]. After the Chinese model. A bootstrap method was used to construct 2000 adaptation, it is used to measure the satisfaction degree samples for mediation analysis, and the significance of of nurses in communicating with patients, their families each path coefficient was tested at α = 0.05. In the tested and medical staff in various aspects of interpersonal model, all coefficients reached the level of significance. communication in nursing work. The scale has a total of The specific values, significance, reliability, validity, and 20 items, divided into 3 dimensions: “overall satisfaction convergence of each parameter are shown in Table 1. with the conversation”, “individual response to conversa- tion”, and “free interaction”. All items were rated on a Results Likert scale, with “1” standing for “very inconsistent” Participants and “5” standing for “very consistent”. The higher the 1475 clinical nurses, aged 21–59 (32.51 ± 7.00) years old; score, the more satisfied the individual is with the com- 97.42 % of them are women; most of the years of service munication. The scale was valid and reliable with a in the hospital are 6–10 years, accounting for 36.07 %; Cronbach’s α coefficient of 0.887 in this study. 70.98 % of them have a bachelor degree; Internal medicine nurses accounted for 28.47 %, surgical nurses Data collection accounted for 25.36 %, and intensive care unit nurses Use paper questionnaires. With the help of hospital ad- accounted for 13.83 %; the average monthly income was ministrators, investigators distributed the questionnaires mostly RMB 6000–8000, accounting for 22.44 %; the Li et al. BMC Nursing (2021) 20:144 Page 5 of 10

Table 1 Parameter significance, reliability and convergence effectiveness of emotional intelligence, empathy, communicate satisfaction and job well-being (n = 1475) Variable Indicator Parameter significance assessment Factor SMC CR AVE Loading Unstd. S.E. t-value P Emotional intelligence Self-emotional perception 1 0.616 0.379 0.815 0.526 Emotion regulation 1.705 0.079 21.606 <0.001 0.762 0.581 Emotional use 1.608 0.073 22.065 <0.001 0.801 0.642 Recognize other’s emotions 1.421 0.069 20.723 <0.001 0.709 0.503 Empathy Perspective taking 1 0.470 0.221 0.755 0.524 Compassionate care 3.170 0.228 13.925 <0.001 0.932 0.869 Standing in patient’s shoes 2.904 0.174 16.703 <0.001 0.695 0.483 Communication Overall satisfaction with the conversation 1 0.843 0.711 0.799 0.581 satisfaction Individual response to conversation 0.619 0.033 18.866 <0.001 0.515 0.265 Free interaction 1.305 0.056 23.455 <0.001 0.876 0.767 Job well-being Welfare treatment 1 0.690 0.476 0.883 0.603 Interpersonal 0.804 0.030 26.604 <0.001 0.772 0.596 Work value 0.862 0.030 28.790 <0.001 0.850 0.723 Managers 1.058 0.040 26.158 <0.001 0.757 0.573 Working characteristics 1.006 0.036 27.580 <0.001 0.805 0.648 Notes: Unstd. means unstandardized regression, S.E. represents the standard error of the estimated parameter coefficient, SMC stands for squared multiple correlations, CR signifies composite reliability, AVE denotes average variance extracted number of nurses in the formal establishment was only between Emotional intelligence and job well-being was 19.86 %; Only 27.05 % of nurses received training related strong (r =0.570, P < 0.001), which was in line with our to emotion management. hypothesis.

Nurse’s job well-being score Mediation model construction The total score of nurses’ job well-being was (83.61 ± This study used structural equation model to explore 12.63), and the average score was (4.40 ± 0.67). The aver- the relationship between variables, and to investigate the age score of each dimension is from high to low: inter- mediating role of empathy and communication satisfac- personal, manager, job value, job characteristics, and tion. The structural equation consists of four latent vari- welfare treatment, as shown in Table 2. ables: emotional intelligence, empathy, communication satisfaction, and job well-being. The observed variables Correlation analysis of latent variables are composed of different dimensions Table 3 shows the correlations between the variables. of these scales. “e” represents the residual error of each Emotional intelligence, empathy, communication satisfac- observed variable, which can be regarded as each ob- tion, and job well-being were all significantly correlated in served variable to estimate the measurement error of the the expected direction (positive). These correlation latent variable. The final structural equation model is coefficients presented moderate effects (r ranging from shown in Fig. 1. Owing to the large sample size, the 0.346 to 0.570, P < 0.001), the positive relationship Bollen-Stine method was adopted to correct the match (Bollen & Stine, 1992). After modification, the fitting in- dexes of each model were relatively good: root mean Table 2 Participants’ job well-being score square error of approximation (RMSEA) was < 0.08, Variables The total score The average score comparative fit index (CFI) was > 0.90, goodness of fit Mean (SD) Mean (SD) index (GFI) was > 0.90, and normal fit index (NFI) was Job well-being 83.16 (12.63) 4.40 (0.66) > 0.90. The fitting index of the model is good and ac- Welfare treatment 15.10 (3.87) 3.77 (0.97) ceptable (χ2/DF = 1.160, RMSEA = 0.010, CFI = 0.999, Interpersonal 19.41 (2.78) 4.85 (0.69) GFI = 0.991, NFI = 0.991). Work value 22.63 (3.38) 4.53 (0.68) Mediation model validation and effect analysis Managers 13.77 (2.80) 4.59 (0.93) The mediation model between emotional intelligence, Working characteristics 12.71 (2.50) 4.24 (0.83) empathy, communication satisfaction and job well-being Li et al. BMC Nursing (2021) 20:144 Page 6 of 10

Table 3 The correlation of job well-being, emotional intelligence, empathy, and communication satisfaction (r value, n = 1475) Variables 1 2 345678 2. Welfare treatment 0.808 3. Interpersonal 0.805 0.485 4. Work value 0.806 0.555 0.683 5. Managers 0.819 0.591 0.634 0.598 6. Working characteristics 0.824 0.584 0.573 0.714 0.588 7. Emotional intelligence 0.570 0.384 0.471 0.616 0.392 0.489 8. Empathy 0.405 0.246 0.384 0.403 0.324 0.329 0.346 9. Communication satisfaction 0.564 0.357 0.481 0.606 0.392 0.507 0.568 0.519 Notes: All P values < 0.001. “1” stands for “Job well-being” is shown in Fig. 1. After increasing the two mediating variable and the effect value of the mediating path are variables of empathy and communication satisfaction, shown in Fig. 1; Table 4. The 95 % confidence interval of the direct effect of emotional intelligence on job well- the mediating effect from emotional intelligence to job being decreased from 0.701 (P < 0.001) to 0.448 (P < well-being was [0.012, 0.466], and the range did not in- 0.001). Emotional intelligence had a significant positive clude 0, and Z > 1.96, indicating that the mediating effect predictive effect on empathy (β = 0.362, P < 0.001) and of the model was significant. All assumptions are true. communication satisfaction (β = 0.572, P < 0.001). Empathy had a significant positive predictive effect on Discussion communication satisfaction (β = 0.314, P < 0.001) and job In contrast to traditional psychology, positive psychology well-being (β = 0.104, P < 0.001). Communication satis- emphasises the exploration of positive factors in life. faction had a significant positive predictive effect on job More people are increasingly aware of the importance of well-being (β = 0.317, P < 0.001). discovering positive forces from adversity [31]. There- The non-parametric percentile Bootstrap method of fore, job well-being as a positive factor can be applied in deviation correction was used to test the mediation ef- the field of nursing. fect, repeat the sampling 2000 times and calculate the The results of this study showed that the overall score 95 % confidence interval. The results showed that the of nurses’ job well-being was 83.61 ± 12.63. The score total indirect effect was 0.319, the independent mediat- was higher than that of hospital nurses in the Wujiang ing effect of empathy was 0.047, the independent medi- area [32]. This may be due to the different regions and ating effect of communication satisfaction was 0.227, the management structures of the research objects. Clinical chain mediating effect of empathy and communication nurses reported the highest scores on the interpersonal satisfaction was 0.045, the path coefficient of each dimension (4.85 ± 0.69). We can see that patients and

Fig. 1 Multiple mediating models of empathy and communication satisfaction between emotional intelligence and job well-being. Note: AllP values < 0.001. The figure is a normalized coefficient graph Li et al. BMC Nursing (2021) 20:144 Page 7 of 10

Table 4 The mediating effect of empathy and communication satisfaction between emotional intelligence and job well-being Paths Point Product of Bootstrapping Two-tailed estimate coefficients significance Percentile 95 % CI Bias-corrected 95 % CI SE Z Lower Upper Lower Upper Emotional intelligence→Empathy→Job well-being 0.047 0.016 2.938 0.019 0.079 0.030 0.066 < 0.050 Emotional intelligence→Communication satisfaction 0.227 0.033 6.879 0.166 0.295 0.020 0.080 < 0.001 →Job well-being Emotional intelligence→Empathy→Communication 0.045 0.009 5.000 0.029 0.066 0.030 0.066 < 0.001 satisfaction→Job well-being Total indirect effects 0.319 0.036 8.861 0.254 0.393 0.255 0.395 < 0.001 Notes: Standardized estimating of 2000 bootstrap sample colleagues are an important source of nurses’ job well- are good at relieving the pressure and discomfort caused being. As a positive emotion, job well-being can improve by the contradiction between nurses and patients by mod- personal and organisational performance and enable erating their own emotions. With the increase of commu- nurses to show higher work enthusiasm and creativity nication with patients, the nurses’ abilities to express and [33]. Therefore, it is necessary for nursing managers and communica are effectively exercised, and their communi- educators to implement relevant interventions to im- cation satisfaction is enhanced [40]. Empathy has a prove nurses’ job well-being. positive predictive effect on communication satisfaction. In this study, emotional intelligence had a significant The realisation of nurses’ empathy is based on nurse–pa- positive predictive effect on job well-being, which tient communication. In communication, the nurse im- supports Manse’s[34] research results that showed that agines themself in the patient’ssituationandexperiences people with high emotional intelligence can better emotional resonance [41]. perceive the emotions of others. Further, they are good The research results show that in addition to the dir- at psychological adjustment and the management of per- ect effect of emotional intelligence, it can also affect on sonal emotions, and thus are able to avoid depression job well-being through the indirect role of empathy, The and hide emotions. It reduces negative behaviours, higher the level of emotional intelligence in nurses, the reduces nurse–patient conflicts, and enhances job well- higher is their empathy and the stronger is their sense of being. However, different studies have shown that exces- job well-being. However, the mediating effect of em- sive emotional attention to patients will increase the pathy is low. Research has also suggested that empathy nurse’s own emotional energy consumption, and when might impact nurses negatively. Nurses have enhanced their emotional energy is too low, it will turn into physical arousal due to the experience of long-term negative emotions [35]. Empathy also had a positive emotional resonance with patients. This long-term predictive effect on job well-being. Nurses with high em- arousal is not conducive to the well-being of nurses [42]. pathy tend to empathise more at work, exhibit altruistic In addition, excessive sympathy and care will make and pro-social behaviours, have more harmonious inter- nurses fall into the disadvantaged situation of patients in personal relationships, and experience more happiness the process of empathy, and also empathize with pa- [36, 37]. Moreover, communication satisfaction had a tients’ pain, resulting in negative emotions and lower positive predictive effect on job well-being. According to their job well-being. While the majority of nurses are relevant literature, 49.5 % of nurse–patient disputes were expected to empathise and care for patients, they also not caused by medical accidents but rather by improper need to be empathized and cared for, so as to ultimately communication [38]. Good communication skills can increase their happiness. help establish a trusting nurse–patient relationship, In addition to the mediating role of empathy, commu- establish a harmonious and comfortable working envir- nication satisfaction also plays a partial mediating role onment, and improve the job satisfaction and job happi- between emotional intelligence and job well-being. The ness of nurses accordingly. Emotional intelligence also higher the nurse’s emotional intelligence level, the had a positive predictive effect on empathy. Related higher is their communication satisfaction and the stron- research has suggested that empathy is an aspect of ger is their job well-being. This mediating role of com- emotional intelligence. In addition, emotional intelligence munication satisfaction indicates that main purpose of also consists of self-awareness, self-motivation, and mental emotional intelligence in nurses’ job well-being is the management [39]. Emotional intelligence has shown a generation of communication satisfaction. Therefore, to positive predictive effect on communication satisfaction. improve clinical nurses’ job well-being, we must pay at- In nursing work, nurses with high emotional intelligence tention not only to the emotional intelligence of the Li et al. BMC Nursing (2021) 20:144 Page 8 of 10

nurses but also to the level of communication satisfac- mediators besides empathy and communication satisfac- tion experienced by the nurses. To effectively improve tion. This will inform the ways nursing managers can job well-being, nursing managers and educators should aim to improve nurses’ job well-being. turn their attention to communication skills training and improving communication satisfaction [43]. Conclusions In addition, emotional intelligence can also improve In summary, the emotional intelligence, empathy, and communication satisfaction by improving empathy, communication satisfaction of clinical nurses cannot be thereby improving job well-being. Under the influence ignored in the quest for job well-being. Nursing man- of emotional intelligence, nurses who perform emotional agers should create a good working environment for management to regulate their emotions, can enter the nurses, optimise the staffing of nurses in various depart- world of their patients with an optimistic attitude and ments, and alleviate their work pressure. Nursing educa- high empathy [44]. By communicating from the perspec- tors should also pay more attention to the mental health tive of the patient, they can perceive patient needs, gain of nurses, conduct psychological counselling in a timely the respect of their patient, experience communication manner, and regularly provide nurses with relevant skills satisfaction, and enhance their job well-being. Therefore, training, such as non-verbal communication training if nursing managers and educators wish to improve the and role-playing exercises. In addition, nurses also need job well-being of clinical nurses, they need to pay simul- self-compassion to enhance their sense of job well-being. taneous attention to emotional intelligence, empathy In the future, interventional research can be conducted and communication satisfaction. on job well-being in the nursing profession. In summary, all our assumptions are valid. Therefore, Abbreviations it is necessary for nursing managers and educators to Unstd.: Unstandardized regression; S.E: Standard error; SMC: Squared multiple train nurses in non-verbal communication training, in correlations; CR: Composite reliability; AVE: Average variance extracted aspects like conveying meaning through methods other than spoken language, including gestures, facial expres- Acknowledgements We would like to express our gratitude to our colleagues who agreed to sions, and even environmental characteristics [45]. They participate to the study. should also train nurses to send, receive, and interpret communication content to improve their communica- Authors’ contributions HC designed the content of this study, XL and HC wrote the main tion skills. In addition, role-playing exercises [46] may manuscript text, QZ prepared Fig. 1, and JY drew the table. RL and YS have value in this respect, in which nurses play the roles participated in data collection and made adjustments to the format of the of patients when discussing medical history and physical manuscript. The manuscript was examined by all the authors, and all authors are responsible for the content and have approved this final version of the examination results. Nurses could thereby express their manuscript. role-play medical history and clinical problems, simulate specific clinical symptoms, and feel the patient’s physical Funding This research was supported by the 2018 Henan Medical Science and condition and emotional experience, which could im- Technology Research Plan Joint Co-construction Project (No. prove nurses’ emotional intelligence and empathy. 2018020929) and National Medical Professional Degree Postgraduate Educa- Training nurses regularly over an extended time could tion Steering Committee (NO. B2-YX20180308-05). The funding of the study was used in the collection and analysis of data. indirectly enhance nurses’ sense of job well-being. Availability of data and materials Limitations The datasets used and/or analysed during the current study are available. Although a chain mediating effect of empathy and com- Declarations munication satisfaction on the relationship between emotional intelligence and job well-being was demon- Ethics approval and consent to participate strated, this study had some limitations. First, the cross- This study has been was approved by the Ethics Committee of Xinxiang Medical University (China). Ethics review number: XYLL-2,018,096. All partici- sectional design means we cannot directly derive causal- pants gave their voluntary written informed consent prior to study ity. Second, we only surveyed nurses in one hospital in participation. China; as such, the results may be geographically limited. Consent for publication Third, there are many female nurses and very few male Not applicable. nurses in China. Therefore, 97 % of the participants in this survey were female nurses, and there may be gender Competing interests The authors declare that they have no competing interests. differences in experiences that were not reflected in the study results. Therefore, in the future, a longitudinal dy- Author details 1 namic study should be conducted with nurses of College of Nursing, Xinxiang Medical University, No.601 Jinsui Avenue, Hongqi District, Henan Province 453003 Xinxiang City, China. 2Nursing different genders working with multiple doctors in dif- Department, The First Affiliated Hospital of Xinxiang Medical University, ferent regions. Further, researchers should explore other Henan Province 453100 Xinxiang City, China. Li et al. BMC Nursing (2021) 20:144 Page 9 of 10

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