Int. Journal of Business Science and Applied Management, Volume 15, Issue 1, 2020
Examining the Moderating Role of Workload in the
Relationship between Emotional Intelligence and Caring
Behavior in Healthcare Organizations
Chiyem Lucky Nwanzu
Department of Psychology, Delta State University
Abraka, Delta State, Nigeria
Tel: +234 8063417245
Sunday Samson Babalola*
School of Management Sciences, University of Venda
Thohoyandou, 0950, South Africa
Tel: +27159628258
Caring behavior is fundamental in the healthcare setting. This study examined the moderation role of
workload in predicting the relationship between emotional intelligence and caring behavior in
healthcare organizations. This study is a quantitative, cross-sectional survey, and data was collected
through a self-administered questionnaire. The sample comprises 121 healthcare professionals,
including medical doctors, nurses, pharmacists, laboratory scientists, and medical records officers in
publicly-owned hospitals. The sample size consists of 30% males and 70% of females with a mean age
of 41.32 years (SD = 10.25). Results revealed that emotional intelligence has a positive and significant
predictive relationship with caring behavior, and that workload has a negative but non-significant
interaction effect in the relationship. The findings suggest that emotional intelligence and the volume of
work tasks employees are engaged in could have an impact on work outcomes. This knowledge has
practical implications for human resource management in terms of recruitment, selection, job
assignment, and further training of employees.
Keywords: emotional intelligence, cross-sectional design, workload, affective event theory, healthcare
Int. Journal of Business Science and Applied Management /
Employees come into the work organization with a varied form of intelligence that influenced
their work behavior with consequences for the effective functioning of the organization (Kalairasi,
Amarayathi, & Soniya, 2014). Among such attributes is emotional intelligence (EI), which is the ability
to perceive, control, and evaluate emotions (Goswami & Talukdar, 2013). It is one of the
organizationally desirable practices that is receiving substantial research concern alongside caring
behavior. Caring behavior is described as a nurturing manner of relating to other individuals to whom
one feels a personal sense of obligation and accountability. There are some studies on the relationship
between EI and caring behavior in healthcare organizations (Hidayati, Rifai, & Ni'mah, 2017; Johnson,
2017; Kaur, Sambasivan, & Kumar; 2013; Sunaryo, Nirwanto, & Manan, 2017; Wodwaski, 2019),
Nightingale, Spiby, Sheen, and Slade's (2018). A review of EI and caring behavior in healthcare
settings revealed that the studies almost exclusively concentrated on nurses and the nursing profession.
The trend is evidenced in the overriding sample of studies reported in Nightingale et al.'s (2018) review.
There are several review papers (i.e., Abraham & Scaria, 2017; Cleary, West, Lopez, Kornhaber, 2018;
Landa & López-Zafra, 2010; Lewis, 2019; Noquez, 2019; Prezerakos, 2018; Raghubir, 2018; Smith,
Profetto-McGrath, & Cummings, 2009; Thomas & Natarajan, 2017) on EI and Caring behavior.
However, there are two literature review papers on EI and caring behavior in nursing (i.e., Maniago,
2017; Noquez, 2019), while there is no such review on the other healthcare professionals. This
inclination appears to continue beyond the period of the reviews as the few recent and related empirical
and review papers (e.g., Aladhyani, Almotairi, Almutairi, & Alotaibi, 2020; Alsufyani, Baker &
Alsufyani, 2020; Puri & Mehta, 2020) also mostly focus on nurses and the nursing profession.
In healthcare facilities, most health seekers first get in contact with the security officers at the gate,
records personnel who take a record of the patient for the hospital, medical doctors who prescribed the
drugs, pharmacists who dispensed the prescribed medications, and the nurses for the administration of
the drugs to the patient, among others. At every contact, the health seeker needs care; thus, there is a
need to gauge and understand the caring behavior of every group of employees in healthcare
organizations. Therefore, care for the patient is a cumulative experience that builds from contact with
various groups, particularly core health professionals within the health facility. Consequently, the
sample for this study comprises the five core professionals (medical doctors, nurses, medical record
officers, pharmacists, and laboratory scientists) in any health care facility. Unlike the samples used in
the existing studies, which are almost solely limited to the nursing profession, the inclusive sample of
this study is intended to produce results that would represent the culture of caring in the organization.
With the five core professions forming this study sample, the emerging results will be composite,
having implications for broader categories of health care employees rather than only the nurses. The
composite form of results is vital as interventions in health care facilities are typically designed either
for core health professionals or non core health professionals.
More so, in Nightingale et al.'s (2018) integrative review and Maniago's (2017) meta-analysis, the
scarcity of empirical studies that linked EI to caring behavior was noted. Although not pointed out in
the reviews, none of the available studies on the relationship between EI and caring behavior examined
the mechanism behind the widely reported positive relationship. An intervening variable, mostly
represented by the moderator and mediator, has the potential to alter the degree and direction of or
explain the relationship between two or more other variables. As relations between organizational
variables are not usually direct, there is often a need for third variable analysis (Mohr, 1982). The body
of knowledge on how third variables impact a given relationship has a great deal of practical
importance as it guides decisions on "when" and "how" to manipulate the link.
In this study, the workload is examined as a potential moderator in the relationship between EI and
caring behavior in healthcare organizations. In most developing economies, there is a shortage of
employees in healthcare organizations, and this has an impact on their workload (Baethge, Müller, &
Rigotti, 2016). Affective event theory (Weiss & Cropanzano, 1996) explained workload potential as a
moderator in the relationship. The approach proposed that workplace events cause emotional reactions
in employees, which then influence attitudes and practice at the workplace. Workplace events could be
hassles (e.g., co-worker inefficiency and negligence) or uplifts (e.g., co-workers' support) or both.
Inferred from the theory, and applied to the present study, the workload is a hassle that could influence
negative emotions on the part of the employees, and such feelings could impair caring behavior.
However, while the possibility of workload moderating the relationship between EI and caring
behavior is proposed in AET, there is an absence of empirical investigation on the issue. The thesis of
this study is that the degree of EI in healthcare employees will be reflected in their caring behavior and
that the effect of EI on caring behavior will change along with the level of workload experienced. The
purpose of this study is to contribute to the existing knowledge on how EI and workload are related to
Chiyem Lucky Nwanzu and Sunday Samson Babalola
caring practice. This body of knowledge would be of practical value in achieving caring behavior in
healthcare facilities.
2.1 Emotional intelligence
Salovey and Mayer (1990) defined emotional intelligence as the capability to observe the feelings
and emotions of self and others, appreciate differences in the mood and emotions, and to use the
understanding as a guide in one's thinking and behavior. Accordingly, EI has four related mental
abilities dimensions of perception of emotion, emotional facilitation of thought, understanding
emotions, and managing emotions (Mayer and Salovey, 1997) that are express emotions in different
ways. EI, as a phenomenon, is receiving a considerable degree of empirical concern for two reasons.
First, several studies of EI relate to desirable workplace attitudes and behavior. That includes
organizational commitment (Kumari & Priya, 2017), job satisfaction (Uslu & Uslu, 2019), creativity
(Silva & Coelho, 2019), and organizational outcomes such as the intention to leave (Uslu & Uslu, 2019)
and job stress (Leon & Tănăsescu, 2018). And second, there is the understanding that EI can be
positively manipulated and that it is transferable. The proposal that EI is developable and transferable is
getting empirical confirmation. For instance, Motamedi, Ghobari-Bonab, Beh-pajooh, Yekta, and
Afrooz (2017) reported that EI training activities resulted in a significant increase in the EI of single
parented adolescents with an emotional and behavioral problem.
2.2 Caring behavior
Caring is being considerate and assisting someone with basic needs (Watson, 2005), which is
unique to individuals and can be defined based upon physiological, psychological, social, and spiritual
needs (Flynn, 2016). Caring is holistic in the modern health system when it addresses clients' physical,
psychological, spiritual needs and health-related factors (Leathard & Cook, 2009), which are embraced,
cherished and valued by health care professionals (Flynn, 2016). This is because the act of caring is a
robust personal quality, a socially acceptable virtue, and a subjective measure of goodness in society
(Held, 2007). Caring behavior, as evident in practice, is dependent upon variables such as staffing
levels, busy work environments, and individual needs (Ball, 2012). The provision of high-quality care
involves doing the right thing at the right time and improving the wellbeing outcomes with subsequent
influence on families and communities (Booyens, 2008). Relationships among employees can be
threatened by negative behaviors such as conflict, emotional abuse, and incivility due to increasingly
complex and stress-laden work environments (Almost, Wolff, Mildon et al., 2015). Respect and
excellent communication can, therefore, be fundamental to the smooth organizational running and also
a pre-condition for the way people interact as members of a workplace organization (Hammett &
Staeheli, 2011). Watson's (1999) caring theory, which focuses on the interpretation of perceptions of
caring, is useful in gaining an understanding of what constitutes caring behaviors and, importantly, the
caring relationship (Fitzpatrick & Whall, 2005). This relationship depends on the commitment to
protect and enhance human dignity. The caring consciousness of employees is essential to connect with
and understand the patient perspective (Flynn, 2013). The encompassing value of caring behavior calls
for sufficient knowledge of its antecedents.
3.1 Emotional intelligence and caring behavior
Emotional intelligence indicates the ability to understand and manage emotions, and it consists of
several components, including self-awareness, self-regulation, motivation, empathy, and social skills
(Jameson, 2019). These components have inherent characteristics that predispose people to caring
behavior. For instance, aside from the capacities to recognize and understand emotions, self-aware
individuals have a sense of how their actions, moods, and feelings about others take effect. Such
understanding will minimize the expression of hurting behavior and foster a better understanding of
when others need support, which is a foundation for caring. According to Burnard (1992), caring, the
foundation of good nursing, depends on one knowing more about oneself, because one cannot help
other people until one is a bit clearer about oneself. In a review of factors that relate to nurses' caring
behaviors, Prompahaku, Nilmanat, and Kongsuwan (2011) reported two studies (Daodee, 1994; Intong,
Sumalia, Sintara, & Tontheerapat, 2005) that found a positive relationship between self-awareness and
caring behaviors. Empathy is the ability to put oneself in the place of other people so that a person can
visualize and feel the experiences of other(s) from the same perspective. These qualities are likely to
precede caring behavior. It puts emotionally intelligent individuals in an excellent position to exhibit
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behavior that others will find more acceptable and relieving to them. Empirically, empathy has been
found to positively relate to prosocial behavior (Jocelyn et al., 2012). Wilhelm and ́Bekkers (2010)
found that empathic concern is related to many types of helping behavior (nine out of ten assessed in
the study). EI individuals are self-motivating, and caring for others comes from the self rather than
being influenced by extrinsic rewards. Some studies (e.g., Al-Hawary & Banat, 2017; Hee & Binti,
2016) have observed a positive relationship between both intrinsic and extrinsic motivation and nurses'
job performance. EI individuals tend to have strong social skills, are active listeners; they invest in
ensuring healthy social relationships and help others around them to succeed (Cherry, 2020).
Relatedly, an empirical study on the link between EI and caring behavior, is connected with
findings indicating a positive relationship. For instance, Sunaryo et al. (2017) observed a positive effect
of emotional and spiritual intelligence on caring behavior. They noted that EI was not as relevant as
spiritual intelligence in predicting the behavior. According to Rego, Godinho, Mcqueen, and Cunha
(2010), EI accounts for a significant but small unique variation in caring behaviorism. While self-
encouragement dimensions predicted caring behavior most, the impact of the high empathy dimension
could be negative or positive on caring behaviors depending on how other aspects are combined.
Nightingale et al. (2018), in a literature review on healthcare organizations, reported that EI relates both
to physical and emotional caring. It was noted by Kaur et al. (2013) that EI influenced psychological
ownership, burnout, and caring behavior and that while the relationship between EI and caring behavior
was mediated by psychological ownership, burnout mediated the relationship between psychological
ownership and caring behavior.
Existing studies on the relationship between EI and caring behavior solely hypothesized and
analyzed the latter as a composite variable (Hidayati et al., 2017; Kaur et al., 2013; Johnson, 2017).
However, several related studies have revealed that EI relates positively with dimensions of caring
behavior such as respectfulness, assurance, connectedness, and knowledge and skills. For instance, EI
significantly correlated with altruism (Charbonnneau & Nicol, 2002), interpersonal relations and
communication, and the professional development dimension of nurses' performance (Beauvais,
Brandy, O'Shea, & Griffin, 2010), nursing students' clinical/procedural performance skills and their
supportive clinical performance skills (Kim & Sohn, 2019; Ibrahim, Elgzar, Mohamed, & Salem, 2016).
Empathy, a dimension of EI, has positive and indirect effects on job performance knowledge (Kelley,
Justice, Waller, & Johnson, 2013). EI has a significant positive relationship with communication skills
(Raeissi, Zandian, Mirzarahimy, Delavari, Moghadam, & Rahimi, 2020). These outcomes of EI either
represent or lead to caring behavior. Therefore, we hypothesized that:
H1: EI has a positive predictive relationship with (a) caring behavior, (b) the assurance
dimension of caring behavior, (c) the knowledge and skill dimension of caring behavior, (d) the
respectfulness dimension of caring behavior, and (d) the connectedness dimension of caring behavior
among employees in healthcare organizations.
3.2 Workload as a moderator in the relationship between EI and caring behavior
Workload generally refers to the amount of effort a worker makes to meet the demands inherent in
his/her job under defined physical circumstances, concerning the work condition and the varied
mechanisms existing in the job roles. It is the volume of work that is assigned to an individual that he
or she has to complete in a specified time (Chen & Spector, 1992). Therefore, the workload is not an
intrinsic characteristic. Instead, it comes from the relations between what is required to carry out a task,
the conditions under which the job was carried out, and the ability, behaviors, and perception of the
individual who carried out the task (Hart & Staveland, 1988). Workload has been discussed as having
both physical and mental or psychological aspects. The physical workload is about the human task
performance threshold that implies employees' health and safety.
In contrast, mental workload refers to the cognitive performance threshold in matters of
information processing. Some studies exist on the workload and caring behavior relationship. For
instance, Syahridhaa, Sjattar, and Hadju (2015) reported a significant correlation between workload
and the readiness and willingness dimensions of caring behavior. Goh (2017) observed statistically
significantly weak positive and negative relationships between patient satisfaction with nursing care
scores and workload management data, respectively. Mudallal, Saleh, Al-Modallal, and Abdel-Rahman
(2017) showed that work conditions have a direct influence on the quality of care.
As noted earlier in this work, the affective event theory explained how and why the workload
mediates the relationship between EI and caring behavior. The approach draws attention to the effect of
how what employees experienced and perceived at work influence their work attitudes and behavior,
particularly those that have to do with feelings rather than cognition. Several researchers (e.g., Wegge,
Van-Dick, Fisher, West, & Dawson, 2006; Grandey, Tam & Brauburge, 2002; Erol-Korkmazthe, 2010)
have offered confirmation of the theory in varied settings. In particular, Grandey, Tam, and Brauburge
Chiyem Lucky Nwanzu and Sunday Samson Babalola
(2002) reported that negative affectivity is related to adverse emotional reactions at work. Negative
emotional responses were associated with leaving the job and positive affectivity directly related to job
Similarly, an increasing workload goes with the growing demand for physical and mental effort
and time. Such pressure builds two related circumstances for the individual that will impede his or her
caring disposition. An individual experiencing an increase in workload has less time available to show
care to the patients and is likely to experience work overload, which triggers several negative emotions
that are adverse to caring behavior. As Amendolair (2012) observed, time spent with patients was a
predictor of the nurses' ability to express caring behaviors. In addition to the theoretical exposition,
several empirical studies have noted that workload is positively associated with several factors that
impact negatively on caring behavior. Increased workload leads to job stress (Susiarty, Suparman,
Suryatni, 2019), and burnout (Liu & Lo, 2018), among others, and stress and burnout negatively impact
on caring behavior (Sarafis et al., 2016). Burnout mediates the relationship between spiritual
intelligence, psychological ownership, and caring behavior (Kaur et al., 2013).
Similarly, workload relates negatively to several factors that positively impact on caring behavior,
such as job satisfaction (Amendolair, 2012; Tentama, Rahmawati, & Muhopilah, 2019). More so,
workload impacts negatively on job performance (Susiarty, Suparman, & Suryatni, 2019), and caring
behavior is an essential aspect of individual performance in health care facilities. Therefore, it is
hypothesized that:
H2: Workload moderates the positive predictive relationship between (a) EI and caring behavior,
(b) EI and the assurance dimension of caring behavior, (c) EI and the knowledge and skill dimension of
caring behavior, (d) EI and the respectfulness dimension of caring behavior, and (e) EI and the
connectedness dimension of caring behavior in healthcare organizations in such a way that each
relationship becomes significantly negative.
4.1 Sample and Procedure
One hundred and twenty-one healthcare workers were sampled from publicly owned health
organizations. The sample consists of 20 medical doctors, 33 nurses, 20 pharmacists, 22 laboratory
scientists, and 26 medical record officers. The adopted participant sample size of 121 was adjudged
satisfactory as it was inconsistent with Dewberry's (2004) recommendation that when the expected
effect size is unknown, the sample size required for a medium effect size should be adopted. Males
comprise 30%, females 70%, single 18%, and married 82%. Their mean age was 41.32 years (SD,
10.25; range, 40 years). The sample is literate, and that gives validity to the self-report measure adopted.
The questionnaires were administered to the employees at their workplaces. A non-random sampling
technique (convenience) was used in the distribution of the surveys. It is a convenience sample because
the participants used were based on availability. The use of non-random samples is a common feature
in organizational behavior studies, mostly in this research location, where sampling frames are often
not available or exceptionally difficult to access.
5.1 Emotional Intelligence Measure
Hall, Haggerty, Cooper, Golden, and Dornheim's (1998) 33-item scale on EI was adapted. The
tests were based on Salovey and Mayer's (1990) EI model, which has been described as a more
scientifically defensible approach to emotional intelligence, particularly when compared to the Golman
and Gotten models (Epstein & Sharma, 1998). Compared to some measures on EI, Hall et al.'s (1998)
scale has a moderate number of items. In recent times measuring scales with too many questions have
found less favor with researchers as such scales have been widely reported not to have better
psychometric properties than similar measuring scales with fewer items.
5.2 Caring Behavior Measure
Wu, Larrabee, and Putman's (2006) 24-item Caring Behavior Inventory (CBI) was adapted to
accommodate both nurses and other healthcare professionals that participated in this study. The scale
has four dimensions that covered assurance (8 items), knowledge, and skill (5 items), respectfulness (6
items), and connectedness (5 items). Respectfulness entails courteous regard for the other; the
assurance dimension entails investment in the other's need and security, connectedness covered
optimistic and constant readiness on the part of the healthcare worker to help the other, and knowledge
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and skill identified proficient, informed, and skillful healthcare workers. On development of the scale
the authors reported Cronbach’s α = .95 (patients) and α = .96 (employees); test re-test reliability of α
= .88 (patient) and α = .86 (employees).
5.3 Workload measure
The Spector and Jex (1998) 5-item scale was used to measure workload. It is a subjective measure
of workload as it evaluates workload as perceived by workers. Compared with the physiological tests
that assess workload by assessing parameters such as heart rate and blood pressure in response to stress.
The subjective measure is adjudged to be more comfortable in terms of generating data, being less
intrusive, less costly, and having greater validity (Young, Zavelina, & Hooper, 2008). A five-point
Likert method of the summated rating scale (5-strongly agree, 4-agree, 3-undecided, 2-disagree, 1-
strongly disagree) was adopted as it generates sufficient variability in response. Creating acceptable
variance among respondents through scaling gives validity to statistical outputs (Stone, 1978). For all
the scales, scores were computed by averaging each participant's responses to the items.
The study design was cross-sectional as data were collected from the sample at one point in time.
This design is appropriate as the hypotheses tested were in generalized and sweeping forms (e.g., EI
positively and significantly predicts caring behavior among employees in healthcare organizations).
This type of presentation seeks results that have extensive coverage. Therefore, the potential for effects
generalization that is associated with the survey makes it very suitable for this study. Data were
collected and analyzed at the individual level. IBM-SPSS version 26 was used for data analysis.
6.1 Control variables
Gender, age, and marital status were included as control variables in data analysis. Some theories,
such as Eagly and Wood's (2012) sociocultural and Bussey and Bandura's (1999) cognitive, social
learning theory, have acknowledged that these demographic variables influence behavior in social
settings, including work organizations.
6.2 Common method variance
Data were collected with a self-report measure that has the potential for common method variance.
Therefore, some procedural rules that control for common method variance were incorporated in the
design of this study. For instance, the various items that make up the EI, workload, and caring behavior
scales were presented in alternating order on the research questionnaire. This arrangement prevents
similar thoughts from flowing from one item to the other. In the cover letter to the survey, the
participants were assured of their anonymity and confidentiality. The introductory letter also includes
the statement "there is no wrong or right answer." All these aimed at reducing evaluation apprehension
that would enhance honesty in response (Podsakoff, Mackenzie, & Podsakoff, 2012; Tehseen,
Ramayah, & Sajilan, 2017).
7.1 Reliability and validity
Tests of reliability and validity were conducted on the scales. Internal consistency reliability was
tested through Cronbach alpha. Alpha of .78 was obtained on the EI measure, α = .82 for the caring
behavior measure (assurance, α = .88; knowledge and skills, α = .67; respectfulness, α = .76;
connectedness, α = .78), and α = .74 for the workload measure. These statistics indicate that the scales,
except for the knowledge and skills subscale, were of good reliability, as an alpha of .70 or above is
considered satisfactory (Howitt & Cramer, 2011). Content validity was achieved by adopting scales
from the literature (Pejic Bach, Aleksic, & Merkac-Skok, 2018). Cronbach alpha statistics also offered
support for the convergent validity of the scales (Garson, 2013). The obtained Durbin-Watson test
statistics ranged between 1.56 and 1.76, and this is within an acceptable level regarding autocorrelation.
The obtained Variance Inflation Factors (VIFs) statistics were all below ten, and the tolerance statistics
were all above 0.2; these indicate an absence of collinearity in the data (Field, 2013). Table 1 shows the
means, standard deviations, and correlation coefficients on the research variables. The highest mean
value was from the knowledge and skill dimension of caring behavior, while the lowest mean value
was from the workload. On a 5-point Likert scale, the observed means could be considered high. Of the
25 pairs of relationships examined, only two pairs were not significant (p > 0.05). The degree of
correlation between the predictor and criterion variables was modest, indicating the absence of
Chiyem Lucky Nwanzu and Sunday Samson Babalola
multicollinearity in the model. The analysis also revealed that the relationship between EI and caring
behavior was also significant = .53, < .05) when gender, age, and marital status were entered as
control variables. The three control variables were not significantly related to caring behavior when
entered along with EI, gender = -.10, > .05), age (β =.02, > .05), and marital status (β =.09, > .05).
This result ruled out the influence of the demographic variables on the relationship between EI and
caring behavior in healthcare organizations.
Table 1: Mean, standard deviation and correlation matrix on research variables
Note: ** p < .01; EmInt. = Emotional intelligence; WorkL = Workload; Caring = Caring behavior; Assur =
Assurance; Know = Knowledge and skill; Respect = Respectful; Connect = Connectedness
7.2 Hypothesis testing
The hypotheses were tested with regression (Haye, 2013). Regression generally is a parametric
test; therefore, assumptions associated with its usage were taken into consideration. For instance, data
collected were independent of each other. A Likert scaling format was used to achieve interval scaling.
Table 2 shows a regression analysis of the hypotheses tested. The results (first row for each of the five
pairs) indicated that EI positively and significantly predicted caring behavior, the assurance dimension
of caring behavior, the knowledge and skill dimension of caring behavior, the respectfulness dimension
of caring behavior, and the connectedness dimension of caring behavior among participating
employees (β = .37, p < 0.05; β = 36, p < .05; β = .37, p < 0.05; β = 42, p < 0.05; β = 48, p < 0.05).
Therefore, hypothesis 1 ("a" through "e") was supported. The interaction of EI and workload on caring
behavior, the assurance dimension of caring behavior, and the respectfulness dimension of caring
behavior in healthcare organizations was negative, but not significant = -.05, p > .05; β = -.27,
p > .05; β = -.20, p > .05). The interaction of EI and workload on the knowledge and skill dimension of
caring behavior, and the connectedness dimension of caring behavior among participating employees
was positive, but not significant = -.04, p > .05; β = -.21, p > .05). Therefore hypotheses two a, b,
and d were partially supported. Hypotheses 2 c and e were not supported.
Table 2: Predictive relationship between emotional intelligence (EI), workload (WL) and their
interaction on caring behavior and its dimensions
Caring behavior
.37 [.23, .52]
< .001
-.05 [-.24, .15]
> .65
.36 [.20, .52]
< .001
-.27 [-.49, -.06]
< .01
Knowledge and Skills
.37 [.20, .54]
< .001
.04 [-.18, .27]
.42 [.27, .58]
< .001
-.20 [-.41, .01]
> .06
.48 [.30, .67]
< .001
.21 [-.04, .45]
> .11
This study examined the predictive relationship between EI and caring behavior in healthcare
organizations, and the moderator effect of workload on the link. Descriptive statistics revealed a high
degree of EI, workload, and caring behavior among the participants. The model that EI positively and
significantly predicts caring behavior was good, and this offered support for hypothesis 1 ("a" through
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"e"). This result is congruent with the extant literature (Beauvais et al., 2010; Charbonnneau & Nicol,
2002; Hidayati et al., 2017; Kaur et al., 2013; Kelley et al., 2013; Kim & Sohn, 2019). Hypothesis 2a,
which tested for the moderator effect of workload on the relationship between composite EI and caring
behavior, was partially supported as the interaction effect was negative but not significant. Although
the result was not statistically significant, that it was "negative" points to the potential usefulness of the
model and its contribution to the confirmation of affective event theory. Workload plausibly changed
the positive relationship between EI and caring behavior to a negative correlation as high workload is
time-consuming, energy-sapping, and frustrating. These features associated with workload have the
potential to lower both employees' EI and caring behavior (Leon, & Tanasescu, 2018; Sarafis, Rousaki,
Tsounis, et al. 2016; Uslu, & Uslu, 2019).
Two plausible explanations can be offered for the non-significant negative aspect of the
interaction effect. First, the sample size adopted in the study has 80% power (p < 0.05) when the effect
size is medium. The effect sizes observed for the interaction were below a small effect. This statistic
indicates that the sample size adopted is implausible to see "significance" even when it does exist. As
Dewberry (2004) reported, a sample size of 480 is required to detect a significant prediction when it
does exist for a study of two predictors and small effect size. Second, the variance moderator accounts
is typically minimal, being the variance that is left over after considering the variations of the
independent variables (predictor and moderator variables) (Jex, 2002).
Hypothesis 2b on the moderator effect of workload on the relationship between EI and the
assurance dimension of caring behavior was supported as the interaction effect was negative and
significant. Hypothesis 2d on the moderator effect of workload on the relationship between EI and the
respectfulness dimension of caring behavior was partly supported as the interaction effect was negative,
but not significant. A plausible explanation for the findings on these two hypotheses is that the
assurance and respectfulness dimensions of caring behavior are characteristics within the control of the
individual. Therefore, the workload can moderate their relationship with EI. Hypothesis 2c on the
moderator effect of workload on the relationship between EI and the knowledge and skill dimension of
caring behavior and hypothesis 2e on the moderator effect of workload on the relationship between EI
and the connectedness dimension of caring behavior was not supported as the interaction effects were
positive. A plausible explanation for the findings on hypotheses 2c and 2e is that the knowledge and
skill and the connectedness dimensions of caring behavior are traits of personality and intelligence
which are not easily within the control of the individual and, therefore, it is not open to the workload to
moderate their relationship with EI. It could be concluded that in healthcare organizations, EI has a
desirable impact on caring behavior. The workload has the potential to change the positive relationship
between EI and caring behavior to a negative correlation. Although the cognitive, social learning, and
sociocultural theories implicated age, gender, and marital status as control variables, the data analysis
did not offer support for this proposal as a non-significant relationship was observed between the three
demographic variables and caring behavior. However, results from the study of the control variables is
not surprising as it is similar to the extant literature (Harrison, 2019; Liu, Hsu, Hung, Wu, & Pai, 2019).
8.1 Theoretical contribution
The findings of this study have some implications for theory development and confirmation. First,
in varied settings, empirical research on EI and caring behavior is growing with consistent findings that
a positive relationship exists between the variables (Kaur et al., 2013; Nightingale et al., 2018; Rego et
al., 2010; Sunaryo et al., 2017). The finding of the present study is congruent with that of the previous
studies, and in doing so, it contributed to the existing body of knowledge that has value for
management practices. Second, claims abound on the benefits of EI in caring behavior within
healthcare organizations. There is a need for middle-range theory to put the claims in perspective. By
its relatively encompassing population, the present study commenced a process that will result in the
body of knowledge with potential for middle-range theorizing on EI - caring behavior relationships in
healthcare organizations. Third, the sample for each of the studies on EI and caring behavior in
healthcare organizations was either from nurses (e.g., Kaur et al., 2013; Nightingale et al., 2018; Rego
et al., 2010), and on rare occasion from any of the other professions (e.g., Dugan, Weatherly, Girod,
Barber, & Tsue, 2014). In other words, the literature lacked a study with a sample that represents a
number of the various healthcare professions. The numerous existing studies offered information about
the specific group studied rather than the organization. The sample for the present study included five
core healthcare professions, and in the literature, this is a remarkable methodological improvement in
sample composition. Fourth, guided by the related studies (Goh, 2017; Syahridhaa et al., 2015) and
some aspects of affective event theory, it was proposed in this study that workload would moderate the
relationship between El and caring behavior in a negative direction. As expected, the analyzed data fit
the model, and by extension, offers support for both the detailed existing results and the affective event
Chiyem Lucky Nwanzu and Sunday Samson Babalola
theory. Fifth, on the proposals of sociocultural theory and cognitive social learning theory, some
demographics (gender, age, and marital status) were analyzed as control variables in this study.
Contrary to expectation, the demographics do not change caring behavior, so the theories were
consequently disconfirmed in the tested domain.
The advancement of management sciences relies heavily on the development, confirmation, and
disconfirmation of approaches (Edwards, 2010). Finally, as noted in the introduction, previous studies
on EI and caring behavior in healthcare organizations were almost entirely on the direct relationship
between the two variables, and such studies are grossly limited in what they can detect in any given
relationship. The present study has taken the literature further by examining workload as a moderator in
the EI - caring behavior link, and this a remarkable methodological contribution to the existing body of
8.2 Practical implications
EI, as the existing literature and this study show, is of great value to caring practices. The practical
effect of this observation is that the education of healthcare workers should adequately cover EI
management and that human resource management practices should make available employees with
appropriate levels of EI. Having employees with an adequate level of EI is feasible through recruitment,
selection, and training processes. Researchers (such as Dolev & Leshem, 2016; Glar-Corbi, Pozo-Rico,
Pertegal-Felices, & Sanchez, 2018) have documented the efficacy and methods of training that enhance
emotional intelligence. The interaction of EI and workload changed the positive relationship between
EI and caring behavior to a negative correlation. This indicates that high workload has an undesirable
influence on the relationship between EI and caring behavior. This observation implies that the
workload among employees in healthcare organizations should be appropriately managed to prevent it
from weakening the expression of EI that is highly desirable for caring behavior among healthcare
EI and caring behavior are two essential characteristics that employees in healthcare organizations
need for competent individual and organizational functioning. Several studies have examined how
much these features exist and how they are expressed and how the two phenomena relate with each
core healthcare professional, particularly nursing. The present research shared that concern and moved
further to examine the moderation role of workload in EI and caring behavior relationships. This study
confirmed several previous studies that identified the predictive influence of EI on caring behavior and
added a finding of the moderating effect of workload on the relationship. These observations lead to the
following conclusion: for caring behavior, healthcare organizations need healthcare professionals with
a substantial degree of emotional intelligence, and workload for professionals in healthcare
organizations should be within their physical and mental capabilities.
9.1 Limitations and suggestions for future research
This study has some flaws which point to directions for future research. The self-report measure
was the only tool for data collection. Although some procedural measures to control same- source
variance were implemented in the design of this study, some issues such as social desirability bias
associated with self-report measures remain. Future studies should include social desirability item-
scales to identify and removed respondents with that characteristic. The design of this study was cross-
sectional, which does not allow the interpretation of the cause-effect relationship. Future studies should
explore field experiments and longitudinal designs to enable causal explanations. The adopted sample
size can only see significance if the population effect size is medium. More studies on the moderating
role of workload in emotional intelligence-caring behavior relationships should use a sample size that
can detect importance if it does exist even when the population effect size is small. Future research
should examine other models with caring behavior and how much the models are related. Knowledge
from such studies would guide the accumulation and discussion of research findings. The health
seekers need care at every contact (e. g. in making payments at the accounts section) within the facility.
Therefore, empirical concern for emotional intelligence and caring behavior in healthcare organizations
should be extended to non-medical professionals as this would also inform how such groups are
Int. Journal of Business Science and Applied Management /
Abraham, J., & Scaria, J. (2017). Emotional intelligence: The context for successful nursing leadership:
a literature review. Nurse Care Open Acces J, 2(6), 160-164.
Aladhyani, S. I. Z., Almotairi, S. K., Almutairi, N. M. H., & Alotaibi, S. H. A. (2020). Relationship
between nursing leaders' emotional intelligence and nursing staff creativity and innovative work
behavior. Health Science Journal, 14(3), 721
Almost, J., Wolff, A. Mildon, B., Price, S., Godfrey, C., Robinson, S.,… & Mercado-Mallari, S. (2015).
Positive and negative behaviors in workplace relationships: A scoping review protocol. BMJ Open,
5(2), 007685
Alsufyani, A., Baker, O., & Alsufyani, Y. (2020). Consequences of emotional intelligence in nursing:
A concept analysis. Erbil Journal of Nursing and Midwifery, 3(1), 82-90.
Baethge, A., Müller, A., & Rigotti, T. (2016). Nursing performance under high workload: A diary
study on the moderating role of selection, optimization, and compensation strategies. Journal of
Advanced Nursing, 72(3), 545-557
Ball, J. (2012). Insufficient staffing makes good care nigh on impossible. Nursing Times, 108(14-15), 7.
Beauvais, A. M., Brady, N., O'Shea, E. R., & Griffin, M. T. Q. (2011). Emotional intelligence and
nursing performance among nursing students. Nurse Education Today, 31(4), 396-401.
Booyens, S. W. (Ed.). (2008). Introduction to health services management. Lansdowne: Juta and
Company Ltd.
Bussey, K., & Bandura, A. (1999). Social cognitive theory of gender development and differentiation.
Psychological Review, 106(4), 676-713.
Charbonneau, D., & Nicol, A. A. (2002). Emotional intelligence and prosocial behaviors in adolescents.
Psychological Reports, 90(2), 361-370.
Chen, P. Y., & Spector, P. E. (1992). Relationships of work stressors with aggression, withdrawal, theft,
and substance use: An exploratory study. Journal of Occupational and Organizational Psychology,
65(3), 177-184.
Cleary, M., Visentin, D., West, S., Lopez, V., & Kornhaber, R. (2018). Promoting emotional
intelligence and resilience in undergraduate nursing students: An integrative review. Nurse
Education Today, 68, 112-120.
Dewberry, C. (2004). Statistical methods for organizational research: Theory and practice. New York:
Dolev, N., & Leshem, S. (2016). Teachers' emotional intelligence: The impact of training. International
Journal of Emotional Education, 8(1), 75-94.
Dugan, J. W., Weatherly, R. A., Girod, D. A., Barber, C. E., & Tsue, T. T. (2014). A longitudinal study
of emotional intelligence training for otolaryngology residents and faculty. JAMA
Otolaryngology-Head and Neck Surgery, 140(8), 720-726.
Eagly, A. H., & Wood, W. (2012). Social role theory. In P. A. M. Van Lange, A. W. Kruglanski, & E.
T. Higgins (Eds.), Handbook of theories of social psychology, (pp. 458-476). Thousand Oaks, CA:
Sage Publications.
Edwards, R. J. (2010). Reconsidering theoretical progress in organizational and management research.
Organizational Research Methods, 13(4), 615-619.
Epstein, M. H., & Sharma, J. M. (1998). Behavioral and emotional rating scale: A strength-based
approach to assessment, Austin, TX: Pro-Ed.
Field, A. (2013). Discovering statistics using IBM SPSS Statistics, 4th ed. London: Sage Publications.
Fitzpatrick, J. J. & Whall, A. L. (2005). Conceptual models of nursing: Analysis and application. Upper
Saddle River, New Jersey: Pearson Prentice Hall.
Flynn, S. (2016). Who cares? A critical discussion of the value of caring from a patient and healthcare
professional perspective. International Journal of Orthopedic and Trauma Nursing, 20, 28-39.
Flynn, S. D. (2013). Perceptions of care and caring: An orthopedic perspective. Unpublished doctoral
dissertation, University of Liverpool, United Kingdom.
Garson, D. G. (2013). Validity and reliability. USA: Statistical Associated Blue Books Series.
Gilar-Corbi, R., Pozo-Rico, T., Pertegal-Felices, M. L., & Sanchez, B. (2018). Emotional intelligence
training intervention among trainee teachers: a quasi-experimental study. Psicologia: Reflexão e
Crítica, 31(1)
Chiyem Lucky Nwanzu and Sunday Samson Babalola
Goh, M. L. (2017). The quality of nursing care and workload management in a tertiary hospital tending
multicultural patients. Dissertations in Health Sciences, No. 424, University of Eastern Finland,
Kuopio, Finland.
Goswami, K., & Talukdar, R. R. (2013). Relation between emotional intelligence and job stress among
engineers at Managerial level at Public sector organization. IOSR Journal of Humanities and
Social Science, 7(3), 44-47
Hall, L. E., Haggerty, D. J., Cooper, J. T., Golden, C. J., & Dornheim, L. (1998). Development and
validation of a measure of emotional intelligence. Personality and Individual Differences, 25, 167-
Hammett, D., & Staeheli, L. A. (2011). Respect and responsibility: Teaching citizenship in South
African high schools. International Journal of Educational Development, 31(3), 269-276.
Harrison, J. (2019). Student nurses' gender role is a predictor of caring behaviors and critical thinking.
Evidence-Based Nursing, 22(3). 89-89
Hart, S. G., & Staveland, L. E. (1988). Development of NASA-TLX (Task Load Index): Results of
empirical and theoretical research. Advances in Psychology, 52, 139-183.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A
regression-based. New York: Guilford Publications.
Held, V. (2007). The ethics of care: Personal, political, global. New York: Oxford University Press.
Hidayati, L., Rifai, F., & Ni'mah, L. (2017). Emotional intelligence and caring behavior among Muslim
nurses: A study in a religious-based hospital in Surabaya-Indonesia. Advances in Health Sciences
Research, 3, 136-139
Howitt, D., & Cramer, D. (2011). Introduction to SPSS Statistics in psychology for version 19 and
earlier, 5th ed. New York: Pearson.
Ibrahim, H. A. F., Elgzar, W. T. I., Mohamed, R. E., & Salem, G. M. M. (2016). Relationship between
nursing students' emotional intelligence and their clinical performance during obstetrics and
gynecologic nursing practical training. American Journal of Nursing Science, 5(6), 240-250.
Jex, M. S. (2002). Organizational psychology: A scientist-practitioner approach. Canada: John Wiley
and Son.
Johnson, D. G. (2017). Emotional intelligence and caring behaviors: Is there a relationship? Doctoral
dissertation, Gardner-Webb University.
Kalairasi Sarafis, V., Amarayathi, M., & Soniya, T. (2014). Emotional intelligence and organizational
performance. Journal of Exclusive Management Science, 3(1), 1-9.
Kaur, D., Sambasivan, M., & Kumar, N. (2013). Effect of spiritual intelligence, emotional intelligence,
psychological ownership, and burnout on caring behavior of nurses: A cross-sectional study.
Journal of Clinical Nursing, 22(21-22), 3192-3202.
Cox-Kelley, S., Justice, M., Waller, L. R., & Johnson, G. (2013). An exploration of emotional
intelligence and job performance among nurses in rural Texas. American International Journal of
Contemporary Research, 3(7), 1-6
Kim, M. S., & Sohn, S. K. (2019). Emotional intelligence, problem-solving ability, self-efficacy, and
clinical performance among nursing students: A structural equation model. Korean Journal of
Adult Nursing, 31(4), 380-388.
Kumari, P., & Priya, B. (2017). Impact of emotional intelligence on job performance and
organizational commitment among bank managers. International Journal of Interdisciplinary and
Multidisciplinary Studies, 4(3), 300-311.
Landa, J. M. A., & López-Zafra, E. (2010). The impact of emotional intelligence on nursing: An
overview. Psychology, 1(1), 50-58.
Leathard, H. L., & Cook, M. J. (2009). Learning for holistic care: Addressing practical wisdom
(phronesis) and the spiritual sphere. Journal of Advanced Nursing, 65(6), 1318-1327.
Leon, R.-D., & Tănăsescu, R.-I. (2018). Emotional intelligence and occupational stress in Romanian
organizations. Management Dynamics in the Knowledge Economy, 6(1), 51-65.
Lewis, S. L. (2019). Emotional intelligence in neonatal intensive care unit nurses: Decreasing moral
distress in end-of-life care and laying a foundation for improved Outcomes: An integrative review.
Journal of Hospice and Palliative Nursing, 21(4), 250-256.
Int. Journal of Business Science and Applied Management /
Liu, N-Y., Hsu, W-Y, Hung, C-A, Wu, P-L., & Pai H-C. (2019). The effect of gender role orientation
on student nurses' caring behavior and critical thinking. International Journal of Nursing Studies,
89, 1823.
Maniago, J. D. (2017). Personality domains and emotional intelligence in the caring nurse-patient
interaction: A meta-analysis. International Journal of Development Research, 7(11), 16951-16959.
Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. J. Sluyter
(Eds.), Emotional development, and emotional intelligence: Implications for educators, (pp. 3-31).
New York, NY: BasicBooks.
Mohr, L. B. (1982). Explaining organizational behavior. San Francisco: Jossey-Bass.
Motamedi, F., Ghobari-Bonab, B., Beh-Pajooh, A., Yekta, M. S., & Afrooz, G. A. (2017). Developing
an emotional intelligence program training and study its effectiveness on emotional intelligence of
adolescents with emotional and behavioral problems that living in single-parent families. Journal
of Education and Learning, 6(2), 101-110.
Mudallal, R. H., Saleh, M. Y., Al-Modallal, H. M., & Abdel-Rahman, R. Y. (2017). Quality of nursing
care: The influence of work conditions, nurse characteristics, and burnout. International Journal of
Africa Nursing Sciences, 7, 2430.
Nightingale, S., Spiby, H., Sheen, K., & Slade, P. (2018). The impact of emotional intelligence in
health care professionals on caring behavior towards patients in clinical and long-term care
settings: Findings from an integrative review. International Journal of Nursing Studies, 80, 106-
Noquez, A. (2019). Emotional intelligence in nurses and emerging trends: An integrative literature
review. International Journal of Nursing, 6(1), 12-18.
Noquez, A. (2019). Emotional intelligence in nurses and emerging trends: An integrative literature
review. International Journal of Nursing, 6(1), 12-18
Pejic Bach, M., Aleksic, A., & Merkac-Skok, M. (2018). Examining determinants of entrepreneurial
intentions in Slovenia: Applying the theory of planned behavior and an innovative cognitive style.
Economic research-Ekonomska istraživanja, 31(1), 1453-1471.
Podsakoff, P. M., Mackenzie, S. B., & Podsakoff, N. P. (2012). Sources of method bias in social
science research and recommendations on how to control it. Annual Review of Psychology, 63,
Prezerakos, P. E. (2018). Nurse managers' emotional intelligence and effective leadership: A review of
the current evidence. The Open Nursing Journal, 12, 86-92.
Puri, K., & Mehta, M. (2020). The relationship between emotional intelligence and job performance: A
study of hospital employees. International Journal of Scientific and Technology Research, 9(1),
Raeissi, P., Zandian, H., Mirzarahimy, T., Delavari, S., Moghadam, T. Z., & Rahimi, G. (2020).
Relationship between communication skills and emotional intelligence among nurses. Nursing
Management, 27(3).
Raghubir, A. E. (2018). Emotional intelligence in professional nursing practice: A concept review
using Rodgers's evolutionary analysis approach. International Journal of Nursing Sciences, 5(2),
Rego, A., Godinho, L., McQueen, A., & Cunha, M. P. (2010). Emotional intelligence and caring
behavior in nursing. The Service Industries Journal, 30(9), 1419-1437.
Salovey, P., & Mayer, J. D. (1990). Emotional intelligence. Imagination, Cognition, and Personality,
9(3), 185-211.
Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., Bamidis, P., ... & Papastavrou, E.
(2016). The impact of occupational stress on nurses' caring behaviors and their health-related
quality of life. BMC Nursing, 15(1), 56.
Silva, D., & Coelho, A. (2019). The impact of emotional intelligence on creativity, the mediating role
of worker attitudes, and the moderating effects of individual success. Journal of Management and
Organization, 25(2), 284-302.
Smith, K. B., Profetto-McGrath, J., & Cummings, G. G. (2009). Emotional intelligence and nursing:
An integrative literature review. International Journal of Nursing Studies, 46(12), 1624-1636.
Spector, E. P., & Jex, M. S. (1998). Development of four self-report measures of job stressors and
strain: Interpersonal conflict at work scale, organizational constraints scale, quantitative workload
Chiyem Lucky Nwanzu and Sunday Samson Babalola
inventory, and physical symptom inventory. Journal of Occupational Health Psychology, 3(4),
Stone, E. (1978). Research methods in organizational behavior. Glenview, IL: Scott, Foresman.
Sunaryo, H., Nirwanto, N., & Manan, A. (2017). The effect of emotional and spiritual intelligence on
nurses' burnout and caring behavior. International Journal of Academic Research in Business and
Social Sciences, 7(12), 1211-1227.
Syahridhaa, S., Sjattar, E. L., & Hadju, V. (2015). Factors related to nursing caring behavior in dealing
with patients of tuberculosis in Jeneponto. International Journal of Sciences: Basic and Applied
Research, 24(2), 21-32.
Tehseen, S., Ramayah, T., & Sajilan, S. (2017). Testing and controlling for common method variance:
A review of available methods. Journal of Management Sciences, 4(2), 142-168.
Thomas, D. S., & Natarajan, J. R. (2017). Emotional intelligence among nursing students-An integrated
review. IOSR Journal of Nursing and Health Science, 6(1), 81-89
Uslu, O., & Uslu, M. (2019). The impact of emotional intelligence on employees' attitudes. Journal of
Applied Management and Investments, 8(1), 32-43.
Watson, J. (1999). Postmodern nursing and beyond. New York: Churchill Livingstone.
Watson, J. (2005). Caring science as sacred science. Philadelphia: FA Davis.
Weiss, M. H., & Cropanzano, R. (1996). Affective event theory: A theoretical discussion of the
structure, causes, and consequences of affect experience at work. In B. M. Staw & L. L.
Cummings (Eds.), Research in organizational behavior: An annual series of analytical essays and
critical reviews, (Vol. 18, pp. 174). Greenwich, CT: Elsevier Science/JAI Press.
Wodwaski, N. (2019). Significance of emotional intelligence on the caring behaviors of first-year
prelicensure nursing students. International Journal of Healing of Caring, 19(2).
Wu, Y., Larrabee, J. H., & Putman, H. P. (2006). Caring behaviors inventory: A reduction of the 42-
item instrument. Nursing Research, 55(1), 18-25.
Young, G., Zavelina, L., & Hooper, V. (2008). Assessment of workload using the NASA Task Load
Index in perianesthesia nursing. Journal of PeriAnesthesia Nursing, 23(2), 102-110.