Exploring the relationship between emotional intelligence and communication skills in nurses: a cross-sectional study

Abstract

Aim

Patients’ outcomes could be improved by using emotional intelligence (EI) in communication. Many of the behavioral skills of nurses are shaped by their EI. This study aims to explore the relationship between the communication skills of nurses working in hospitals and their EI, emphasizing the importance of communication abilities.

Method

This cross-sectional study included 350 nurses as a convenience sampling technique working in four government and private hospitals in the southern West Bank of Palestine. The questionnaire consisted of three sections: sociodemographic, EI Goleman’s questionnaire, and communication skills questionnaire. Participants completed a communication skills questionnaire developed by the researcher, along with Goleman’s EI Scale. The validity and reliability of the tools were assessed throughout the study. Data analysis was conducted using descriptive statistics, analysis of variance, and Pearson’s correlation test in SPSS v27.

Results

The self-awareness dimension achieved the highest score of 25.50, whereas self-management recorded the lowest at 19.69, resulting in an estimated average EI score of 87.22. In terms of communication instruments, a total possible score ranges from 28 to 140, with higher mean scores indicating high EI. The overall average score for communication skills was 90.23. A significant correlation. For EI, a total possible score ranging from 28 to 140, with higher mean scores indicating high EI. was observed between the total EI score and the overall communication skills score (r = 0.542, p < 0.01), and all four EI dimensions were strongly correlated with the total communication skills score.

Conclusion

As EI and its dimensions positively influence nurses’ communication skills, hospital managers can enhance EI by organizing training sessions, promoting communication skills, and establishing a foundation for continuous improvement in hospital services. The in-service training, including monthly meetings and conferences, would benefit nurses by engaging them with EI. Using artificial intelligence could engage nurses in training sessions.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03679-5.

Introduction

Emotional Intelligence (EI) is a multi-faceted framework composed of four key components: self-awareness, self-regulation, self-motivation, and communication/relationship management [1]. Self-awareness refers to the recognition of one’s emotions, while self-regulation involves maintaining emotional balance. Self-motivation is focused on achieving effectiveness and drive [1]. The healthcare industry is a complex and dynamic subject that requires professionals to possess strong interpersonal and emotional skills in addition to technical expertise. Particularly important to patient care are nurses, who frequently act as the main point of contact for patients and their families. Building trust, delivering high-quality treatment, and guaranteeing patient safety all depend on their ability to communicate effectively [2]. In order to facilitate successful communication skills that foster trust and create enduring, meaningful relationships, EI makes use of awareness, emotional control, and honesty [3]. To improve communication skills, nurses should work on building their EI, which has a direct impact on how well they communicate effectively and engage with patients and families. This includes comprehending and managing one’s own emotions, as well as recognizing and responding to the emotions of others [4]. However, communication in nursing extends beyond simply sharing information; it also requires managing emotionally sensitive situations, addressing patients’ concerns, and collaborating closely with multidisciplinary teams. In this regard, EI has become an essential skill that supports effective communication and improves overall job performance and patient outcomes [2]. Emotional Intelligence in nursing allows practitioners to handle stress effectively, respond empathetically to patients’ needs, and stay calm in high-pressure situations. Research indicates that nurses with high EI are more skilled at managing the emotional challenges of their work, which improves their communication abilities and strengthens their therapeutic relationships with patients [5]. Moreover, EI has been linked to key outcomes such as organizational commitment, teamwork, and job satisfaction—factors that are essential for sustaining a motivated and engaged nursing workforce [6].

Additionally, effective communication plays a vital role in patient outcomes and is a fundamental aspect of nursing practice. Nonverbal cues such as body language, tone of voice, and active listening are equally important to successful communication as verbal exchanges [7]. Nasiripour and Saeedzadeh [8] found that nurses with strong communication skills generally perform better than their peers. Nasiripour and Saeedzadeh [8] also indicated that nurses are less prone to experiencing career-related pressure and stress, which will be positively reflected in the provided care to patients. Koh [9], who studied the influence of EI on interpersonal communication, concluded that individuals with high EI are more adept at managing their emotions and handling challenges in a logical manner [10]. Moreover, nurses need to be skilled in adapting their communication approaches to meet the needs of diverse patient groups, including individuals with different ethnic backgrounds, literacy levels, and emotional conditions. Poor communication has been recognized as a leading cause of adverse events and medical errors in healthcare settings [11]. Conversely, effective communication enhances patient satisfaction, adherence to treatment plans, and overall healthcare quality [9].

Effective communication is at the core of nursing practice. It fosters trust and rapport between nurses and patients while ensuring the accurate exchange of information. Communication skills are particularly important in situations where patients may feel vulnerable or anxious about their health. Beyond addressing patients’ emotional needs, nurses must also be capable of conveying complex medical information compassionately and understandably [12]. Communication skills are essential for effective teamwork in healthcare, in addition to interactions with patients. Nurses often serve as intermediaries between patients’ families, doctors, and other healthcare providers. Misunderstandings or disruptions in the flow of information can greatly impact patient safety. Therefore, developing strong communication skills by incorporating EI is crucial for ensuring seamless coordination across different levels of care [13].

The evidence demonstrates the need to uphold the Palestinian population’s right to freedom as well as justice and equality. In addition to traffic closures, the Israeli Separation Wall has a detrimental impact on Palestinian patients’ quality of life and mental health since it restricts their access to healthcare facilities in the Gaza Strip, West Bank, and East Jerusalem [14]. Thus, the aforementioned obstacles in the Palestinian setting highlighted the necessity of researching nurses’ emotional intelligence and communication in order to overcome them. Although research on the impact of EI on communication skills in nursing practice is common globally, such studies are lacking in Palestine. Therefore, this study fills an important gap by examining how EI influences communication skills among nurses working at private and governmental hospitals in the southern West Bank in Palestine. In this study, there are two main research questions. The first one is there an association between EI and communication skills among nurses in Palestine? The second one examines whether socio-demographic characteristics of the participants in the study, such as whether they were male or female, and their level of education, affect the EI and communication skills among nurses in Palestine?

Methods

Setting and design

A descriptive cross-sectional study design was employed to examine the relationship between EI and communication skills among nurses working in different wards and units of both private and public hospitals in the cities of Hebron and Bethlehem, located in the southwest of the West Bank. Each of these cities has over five private and governmental hospitals. Using a simple random sampling method within each city, the selected hospitals for the study included Bethlehem Arab Society for Rehabilitation, Al-Ahli Hospital, Beit-Jala Hospital, and Hebron Governmental Hospital. When there was no national organization ensuring that people with disabilities could fulfill their right to rehabilitation, the Bethlehem Arab Society for Rehabilitation (BASR) was founded in 1960. The goal of BASR, a non-governmental non-profit organization, is to create an inclusive society where everyone has access to healthcare and rehabilitation services. In order to provide services that promote inclusive, community-based development, BASR uses the rights-based approach. Currently, BASR employs more than 350 people in three main areas: community-based rehabilitation, specialized rehabilitation, and medical operations and treatments. Al-Ahli Hospital was constructed in 1988 AD on 27,500 thousand square meters. Over time, further departments and sections were built, increasing the hospital’s size to 30,000 square meters, with 304 beds available when the project was finished. Beit Jala Governmental Hospital or Al-Hussein Governmental Hospital is a government hospital in the Beit Jala city, West Bank, Palestine. Followed by the Palestinian Ministry of Health. It was built in 1955 and has 131 beds. Princess Alia Governmental Hospital, or Hebron Governmental Hospital, is a government hospital in Hebron city, West Bank, Palestine. It is managed by the Palestinian Ministry of Health. It was built in 1957 and has 237 beds. Data collection took place from January to February 2025.

Sample

The Raosoft sample size calculator recommended a sample size of 335, but the final sample size was adjusted to 370 to account for a 10% attrition rate. A convenience sampling technique was used to select 370 participants. Of the 370 surveys distributed, 358 were returned, and 350 were fully completed, resulting in a 94.60% response rate. The collected data was then coded and entered into the system.

Inclusion and exclusion criteria

The study included registered nurses with at least one year of experience working in various wards and units. However, it excluded registered nurses with less than a year of experience, managers, and those who had participated in the pilot study.

Data collection tools

The instruments used for data collection included three sections. The first one was a demographic questionnaire, which was developed by the authors based on literature such as age, sex, and educational level. The second one was Goleman’s EI Scale, which is valid and reliable and previously published [15]. The third section was a communication skills questionnaire, which was developed by the researcher (see supplementary files). The communication questionnaire was designed based on a literature review and the Shannon and Weaver communication model [16]. The demographic questionnaire captured variables likely to influence EI and communication skills, such as age, gender, job type, and experience, educational background, organizational position, marital status, managerial and training history, as well as details about the hospital, workplace, and work shifts.

Goleman’s EI Scale, validated by Madani, Bamdad Partovi [17] in 2014, contains 28 items assessing EI across four dimensions: self-awareness, self-management, social awareness, and social skills. The scale demonstrated good internal consistency, with a Cronbach’s alpha of 0.87 [18]. In the current study, the reliability was reassessed, yielding a Cronbach’s alpha of 0.871. Each of the four dimensions consists of seven items, with responses scored on a scale from 1 (‘never’) to 5 (‘always’), resulting in a total possible score ranging from 28 to 140, with higher mean scores indicating high EI.

To evaluate communication skills, a questionnaire consisting of 24 items was used. These items covered key areas such as building a harmonious relationship, active listening, identifying patients’ problems, validating emotions, encouraging joint participation, and delivering effective information. The items were rated on a five-point Likert scale, adapted from communication skill components found in previous questionnaires [16, 19], resulting in a total score ranging from 0 to 96. Content validity was assessed by five experts in research methods, communication, and nursing education using the Content Validity Ratio (CVR), with all items scoring above 0.78. The reliability of the instrument was confirmed through a pilot study, yielding a correlation coefficient of 0.89.

We separated the communication skills levels into three categories for the grading method. Low communication skills are indicated by a score of less than 32, moderate communication skills are indicated by scores between 33 and 64, and excellent communication skills are indicated by scores of 65 and higher.

Data analysis

To assess the normality of data, the Kolmogorov-Smirnov test showed no significant results and indicated that the data followed a normal distribution. Data was analyzed using Statistical Package of Social Science (SPSS, Chicago, IL, USA) version 27.0, applying descriptive statistics, Cronbach’s alpha, and Pearson’s correlation coefficient.

Ethical consideration

This study was approved by the Ethics Committee of the Faculty of Health Professions at Al-Quds University, Ref No: (RESC 2025-51). The nurses voluntarily participated in the study and completed the questionnaires. Both personal information and data confidentiality were guaranteed, ensuring that no harm was caused to individuals or organizations. Informed consents were obtained from all participants. Data collection occurred with formal approval granted by the nursing director of the participating hospitals. The nurses were informed about the study’s purpose, scope, and significance, and data collection began only after obtaining their consent. Four research assistants, trained specifically for this study, administered the questionnaires in person. Before participants submitted their forms, the research assistants verified that all data were complete. The data collection period lasted for five weeks.

Results

A total of 350 nurses participated in this study, with a response rate of 94.59%. In terms of the Participants’ sociodemographics, 39.5% were men 60.6% were women. The majority of participants, 61.4% were aged between 25 and 35. 37.1% had less than five years of experience, while 20.1% had six to ten years of experience. The majority of participants, 73.4% held a bachelor’s degree in nursing science. More details are presented in Table 1.

Table 1.

Participants’ profile summary (N = 350)

Characteristics		Frequencies	Percentages (%)
Gender	Male	138	39.4
	Female	212	60.6
	Total	350	100%
Age-group	less than 25	101	28.9
	25–35	215	61.4
	more than 35	34	9.7
	Total	350	100%
Years of Experience	1–5 years	111	31.7
	6–10 years	102	29.1
	11–16 years	54	15.4
	more than 16 years	83	23.7
	Total	350	100%
Level of Education	Diploma	36	10.3
	Bachelor	257	73.4
	Master	57	16.3
	Total	350	100%
Hospital Setting	BASR hospital	84	24.0
	Al-ahli hospital	81	23.1
	Hebron hospital	88	25.1
	Beit-Jala hospital	97	27.7
	Total	350	100%

The EI Questionnaire consisted of 28 questions, with scores ranging from 1 to 5. The range of the total score of this questionnaire is from 28 to 140; the higher the score, the higher the EI level. The total score of the EI was 87.22 ± 8.73. The score of each part of the questionnaire is shown in Table 2. Of the four dimensions, the highest and lowest scores were found in self-awareness (25.50) and self-management (19.69), respectively. Meanwhile, the average total score for the staff’s communication skills was 90.23 ± 10.56.

Table 2.

Descriptive of the four Sub-Dimensions of the emotional intelligence and communication skills among nurses (N = 350)

Dimensions of Emotional Intelligence and Communication Skills	Mean	Std. Deviation
Self-awareness	25.50	3.16
Self-management	19.69	3.39
Social awareness	20.94	3.14
Relationship management	21.04	2.70
Total Score of Emotional Intelligence	87.22	8.73
Total Score of Communication Skills	90.23	10.56

Table 3 presents the variations in EI, its four dimensions, and communication skills based on nurses’ years of experience. The overall average EI score among the nurses was 87.22, which falls within an optimal range given the total possible score of 28 to 140. Among the EI dimensions, self-awareness had the highest mean score (25.50), while self-management had the lowest (19.69). The average communication skills score was 90.23, indicating a strong level of competency, considering the scale ranges from 0 to 96. Analysis using F statistics revealed significant differences in total EI scores and the dimensions of self-management, social awareness, and relationship management across different experience levels. However, no significant difference was observed in self-awareness. Additionally, nurses’ years of experience did not significantly affect their overall communication skills scores.

Table 3.

Mean difference between the four dimensions, and total scores for emotional intelligence and communication skills, in the years of experience (N = 350)

Dimension		Sum of Squares	df	Mean Square	F	P-value
Self-awareness	Between Groups	5.53	3	1.844	0.184	0.907
	Within Groups	3465.92	346	10.02
Self-management	Between Groups	136.79	3	45.60	4.062	0.007
	Within Groups	3883.73	346	11.23
Social awareness	Between Groups	123.47	3	41.11	4.330	0.005
	Within Groups	3288.71	346	9.51
Relationship management	Between Groups	113.38	3	37.79	5.407	0.001
	Within Groups	2418.33	346	6.99
Total Score of Emotional Intelligence	Between Groups	1141.29	3	380.43	5.170	0.002
	Within Groups	25462.28	346	73.59
Total Score of Communication Skills	Between Groups	517.04	3	172.35	1.555	0.200
	Within Groups	38343.82	346	110.82

Table 4 shows a strong and statistically significant correlation between communication skills and the overall EI score. The strongest correlation (p < 0.00, r = 0.730) was observed in participants’ communication skills and self-awareness dimension, while the weakest correlation (p = 0.00, r = 0.194) was found in participants’ communication skills and self-management dimension.

Table 4.

Correlation between emotional intelligence and its dimensions with communication skills (N = 350)

Correlations
		1	2	3	4	5	6
1- Self-awareness	Pearson Correlation	1
	Sig. (2-tailed)
2- Self-management	Pearson Correlation	0.079	1
	Sig. (2-tailed)	0.140
3- Social awareness	Pearson Correlation	0.227**	0.434**	1
	Sig. (2-tailed)	0.000	0.000
4- Relationship management	Pearson Correlation	0.131*	0.874**	0.248**	1
	Sig. (2-tailed)	0.014	0.000	0.000
5- Total Score of Emotional Intelligence	Pearson Correlation	0.513**	0.842**	0.685**	0.784**	1
	Sig. (2-tailed)	0.000	0.000	0.000	0.000
6- Total Score of Communication Skills	Pearson Correlation	0.730**	0.194**	0.383**	0.211**	0.542**	1
	Sig. (2-tailed)	0.000	0.000	0.000	0.000	0.000

**. Correlation is significant at the 0.01 level (2-tailed)

*. Correlation is significant at the 0.05 level (2-tailed)

Discussion

The main hypothesis of the study suggests that there is a significant and strong relationship between participants’ communication skills and their overall EI score (p = 0.00, r = 0.542). Our findings revealed that the EI mean scores of the nurses were 90 out of 140, indicating a relatively moderate level of EI. Raeissi, Zandian [20] recently reported that nurses exhibited a high level of EI [20]. In contrast, Vahidi, Namdar Areshtanab [21] found that nurses displayed a lack of EI [21]. Additionally, another study suggested that nurses possess a moderate level of EI [22]. It is believed that several factors, such as the nurses’ cultural background, education, self-compassion, empathy, communication skills, and problem-solving abilities, may have contributed to the high EI observed in this study. The study reveals a strong and significant correlation between nurses’ communication skills and EI, along with its dimensions that include self-awareness, self-management, social awareness, and relationship management. Higher levels of emotional intelligence (EI) and its components are often observed in nurses with higher communication skills, allowing them to better meet patient requests and feel more satisfied at work [23]. Our findings show the need to emphasize nurses’ EI levels and connecting them with communication skills in order to provide high-quality care. Nurses play a vital role in delivering healthcare services, and given the nature of their work and the challenges they encounter in clinical environments, they need to have a high level of EI [24]. Therefore, hospitals should offer training programs designed to improve nurses’ EI and encourage them to participate in these courses [25]. The training programs could be as PowerPoint presentations and case studies about EI that could be discussed in groups with a facilitator and participants to capture the concepts of EI and how to use and integrate them in the healthcare settings [25].

In line with previous studies [26–29]. The mean self-awareness score in this study was higher than the scores in the other three EI dimensions (including the self-management scores, social awareness scores, and relationship management scores), with the overall EI score assessed to be at an optimal level. Furthermore, the communication skills score was found to be “very desirable,” which aligns with findings from other studies [28–30].

In this study, male participants demonstrated higher average scores in EI and communication skills compared to females, though the differences were not statistically significant. This aligns with findings from Petrovici, Dobrescu [10] but contrasts with those reported by Mayer, Salovey [31], who, along with later work in 2014, found that women tend to exhibit stronger EI and communication abilities than men. In light of the above findings, it can be explained that women generally show greater sensitivity to visual cues, particularly facial expressions. They are typically more emotionally expressive than men, often smiling and using their facial expressions to convey emotions. Men, on the other hand, tend to be more open in interactions with women than with other men. Women are usually perceived as more extroverted and are often seen as more supportive companions, providing stronger emotional and social support than their male counterparts. Conversely, men tend to be more effective in managing emotions such as fatigue, adapting to new situations, and maintaining a more constructive and hopeful outlook [32, 33]. They also tend to exhibit higher levels of self-confidence and optimism according to Bar-On [32], cope better with change, and handle stress more efficiently [32, 34]. While women are more strongly associated with a sense of social responsibility, men are often linked with greater adaptability to changing environments (Kafetsios et al. 2009). Nevertheless, it is essential to recognize that gender alone does not fully account for individual behavior, as it interacts with various demographic and socio-cultural influences [35].

These variations between the sexes can result from the social, religious, and cultural environment in which the data were gathered. For example, women in Palestine, as an Arab country, still have restricted access to education and employment opportunities compared to men, which emphasizes the need to increase the number of women in the labor and education fields in order to develop their communication and EI [36]. The study also identified variations in EI and communication skills based on work experience. However, differences related to educational level were not statistically significant, consistent with the findings of Kezar, Chambers [37] in 2015. However, these findings contradict a systematic review result that assesses how well emotional intelligence training work and education affect EI and communication, and indicates that education is a significant factor [4]. Previous studies have suggested that communication skills and EI tend to improve with age [30, 38]. In the present research, communication skills appeared to increase with age, as in previous studies, though not to a significant extent. No significant differences in EI were observed across age groups, suggesting that EI and communication skills may not necessarily develop or be consistently applied over time. But another study in Saudi Arabia pointed out that compared to their more junior colleagues, older and mid-career nurses scored higher on EI, indicating that maturity plays a part. These contradictions emphasize the need for further studies in Palestine with a larger sample size, with different settings and research designs, such as qualitative studies [39].

Limitations

While this study showed significant and valuable findings, it is important to acknowledge its limitations. The study was limited to nurses working in hospitals located in the southern region of the West Bank, Palestine. As a result, the findings of the study are limited to this group and may not be generalized beyond it. In addition, using convenient samples and self-administered questionnaires may restrict the generalizability of the findings. Moreover, the answers that nurses provided might have introduced selection bias. It is highly recommended for future studies to use larger random samples from all geographic areas in the country.

Conclusion

It can be concluded that effective communication requires a sufficient level of EI. Nurses who are exposed to EI during their nursing education are more likely to demonstrate EI traits in their practice. Future recommendations suggest that healthcare organizations should offer educational programs on the importance of EI in nursing, and nurse educators should incorporate EI into both pre- and post-licensure curricula. These programs may include, but are not limited to, lectures, role plays, case studies, group discussions, or brief programs on certain subjects of EI, and individual interviews based on an evaluation of the emotional state of the students. Using validated patient experience or satisfaction tools as indirect indicators of nurses’ emotional intelligence, future research could examine the relationship between patients’ perceptions of the emotional support and empathy they receive during care and nurses’ self-assessed emotional intelligence. Analyzing the similarities and differences could help enhance EI to improve patient satisfaction and experiences.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

FG: Conceptualization, methodology, formal analysis, validation, investigation, writing- original draft preparation, visualization, writing- reviewing and editing. FG, KZ, NG, MB, AA, RH, NZ: Conceptualization, methodology, data collection, writing- reviewing and Editing. FG, AA: Conceptualization, methodology, writing- reviewing and editing. The authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All human procedures of the study have been following the ethical standards of the relevant national and institutional committees on human experimentation and with the current version of the Declaration of Helsinki. Institutional Review Board approval was secured from the assigned University in compliance with the research protocol in Palestine, Ref No: (RESC 2025-51). The nurses were informed about the study’s purpose, scope, and significance, and data collection began only after obtaining their consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.