Managerial intelligence, quality of work life and job performance: the experience of nurses in selected public hospitals in Tehran- Iran

doi:10.21203/rs.3.rs-5302410/v1

Background

The quality of work life and managerial Intelligence are important determinants of nurses’ job performance. This study aimed to investigate the relationship between managerial Intelligence and quality of work life and nurses’ job performance in selected referral hospitals affiliated with the Tehran University of Medical Sciences (TUMS), in 2022, in Tehran-Iran.

Methods

This is a descriptive-analytical and cross-sectional research. Our samples were 348 nurses from four selected referral hospitals, affiliated with TUMS. We collected data through a questionnaire covering demographic details, managerial intelligence, quality of work life, and job performance and used SPSS 24 software to conduct descriptive and inferential data analysis.

Results

The average managerial intelligence and quality of work life scores were both 2.42 out of 5 (average), while job performance scored 3.90 (good). There was a significant positive correlation between managerial intelligence and job performance (r = 0.435, p = 0.000). Age and work experience were significantly correlated with managerial intelligence, while job category, income, and hospital were linked to quality of work life. Job performance was related to age, job category, and work experience (p < 0.05).

Conclusions

Enhancing managerial intelligence may directly improve nurses' job performance and indirectly influence their performance through better quality of work life. We propose capacity-building courses and continuous education to improve the nurses’ managerial intelligence and job performance.

Nurses

Managerial Intelligence

Quality of Work Life

Job Performance

Hospital

Tehran University of Medical Sciences

Iran

Human resources for health (HRH) are among the building blocks of any health system; hence determining the factors to enhance their performance level is essential. Job performance is the result of the implementation of tasks conducted by HRH after a certain time, which is considered critical for productivity and efficiency[1]. Various variables, i.e., job stress, organizational justice, internal motivation, emotional intelligence, mental health and quality of working life are related to job performance[2].

Hospitals are among the largest and most complex and comprehensive healthcare settings. On average, in Iran, 50% of all medical personnel are nurses, while in some countries that figure is as high as 80% [3]. Job performance of nurses is defined as being effective in carrying out activities and responsibilities related to direct patient care. Nurses are in close contact with individuals and patients for an important part of their lives. Declining performance of nurses might result in lower productivity, increased costs and patients’ dissatisfaction[4]. On the other hand, undesirable work conditions and stress could have serious effects on people's health and quality of life. As a result, it is crucial to pay enough attention to nurses’ health status and quality of life to protect the health of other citizens[5].

Having a good quality of work life (QWL) is also a very important factor for maintaining the motivation, satisfaction and quality of nurses, which can ultimately play a decisive role in achieving high levels of patient care quality, good job performance, and ensuring the stability of the health system[6]. QWL refers to the level of satisfaction, motivation, involvement, and commitment to people[7]. Other factors, i.e., personality and talent can also affect performance. Talent is a set of people's knowledge, abilities and intelligence. Intelligence refers to people's capacity, ability and skill to understand complex concepts, which in turn can help people solve problems by using logic thinking and reasoning and by learning from experience to better adapt to the environment. Managerial Intelligence(MI) consists of emotional intelligence(EI), Intellectual intelligence or intelligence quotient (IQ) and political intelligence(PI)[8]. Table 1 presents different dimensions of MI.

Table 1

Dimensions of Managerial Intelligence
Dimensions	definition	components
Emotional Intelligence (EI)	• the ability to control emotions and feelings, especially in stressful situations, is one of the most effective elements of performing well. This include the ability to control their own emotions and those of others, to accept the views of others, and to control social relationships and actions [20]. • "a skill which the possessor can master his emotions by self-awareness; improve it through self-management; by empathy, to understand their impact and by managing relationships, to behave in a way that elevates the morale of self and others" [2].	• Self-Awareness · • Self-Management • Social Awareness • Relationship Management.
Political Intelligence (PI)	it is about working with honesty, towards common goals and interests[44.]	• Social astuteness • Interpersonal influence • Networking ability Apparent sincerity
Intellectual intelligence or intelligence quotient (IQ)	It also called intelligence, logical intelligence, cognitive intelligence and abstract intelligence, is the second dimension of intelligence [18] that shows an individual's ability to observe, analyze and interpret situations.	-

Research indicates that EI plays an important role in enhancing nurse-patient communication. Nurses with high EI have strong clinical communication and can easily find ways to solve problems. This not only facilitates communication among nurses, but also increases the quality of care and patient recovery[9]. Considering that nurses face many situations during patient care that they must diagnose and resolve on their own, sufficient IQ to think and resolve these problems is directly related to the health of society. Nurses are in close contact with a wide range of people, including patients, clinicians, and administrators at all levels of the hospital. Consequently, they need social awareness and honesty to be able to communicate effectively and solve obstacles and problems in different situations for their own benefit and their patients' benefit. People who are politically intelligent are highly self-aware, flexible and opportunistic, and can communicate well with others[8].

In light of these definition, and given scarce applied research to identify and analyze the factors affecting nurses’ performance in hospitals, this paper reports a research conducted in selected hospitals affiliated with TUMS in winter 2022 aiming to assess the relationship between nurses’ MI, QWL, and job performance, during Covid-19 crisis.

This is a descriptive-analytical and cross-sectional study. Our samples were nurses working at four hospitals with the largest number of nursing staff among the seven referral hospitals for Covid-19 affiliated with TUMS. Table 3 illustrates that the selected hospitals represent half of TUMS' clinical staff and recruit 2593 nurses. We used Cochran's formula at the 95% confidence level, which determined the number of nurses needed in the final sample to be 334. The sampling methodology was multistage and quota-based. Following hospital selection, the resulting sample volume was distributed among hospitals based on the size of the qualified nursing community within each hospital. At each hospital, we selected the samples using a simple random method, and substituted unwilling nurse to complete the questionnaire with another nurse.

The data collection tool was a four-part questionnaire consisting of demographic, managerial intelligence, quality of work life and job performance information (appendix 1). The demographic information section included gender, age, marital status, blood group, job category, work experience, educational status, type of employment, amount of salary and benefits received, service department, hospital, and records of participation in management courses.

The second part included 36 items in three dimensions of intellectual intelligence, EI and political intelligence [18]. We used the short form of this questionnaire, including eight questions within each dimension of the questionnaire, and verified its appearance and content validity, Cronbach alpha stands at 0.917 [4]. This questionnaire ranges the MI of individuals from 0 to 5.

In the next section, we used a shortened version of the quality of working life (QWL) questionnaire, originally consisting of 36 questions in 9 dimensions: participation in the organization, job promotion, solving individual problems, communication, motivation, job security, salary and wages, job honor and job stress[10]; shortened into 18 questions. The Cronbach correlation coefficient of this questionnaire was 0.91, confirming its validity. The average QWL score for nurses, ranges from 1 to 5.

For the final part, we designed the nurses’ job performance questionnaire based on a 5-point Likert scale, comprising of 16; whose final outcome varies from 1 to 5. A group of 14 experts (healthcare management experts, nursing management experts, matrons and supervisors) validated the content of the questionnaire, which gained Cronbach's alpha index of 0.883 for all questions for its reliability. We emailed the questionnaire and the validity determination form to nurses and, after some time, received their responses via e-mail. Further, our pilot study to measure the reliability of nurses' job performance questionnaire, scored the reliability of MI (Cronbach's alpha = 0.813) and QWL (Cronbach's alpha = 0.868) questionnaires.

We distributed 380 questionnaires among nurses across the four hospitals and received 91% response (Table 2). We used SPSS 24 software for descriptive statistics, correlation tests, including the percentage of frequency, the average standard deviation and the Spearman correlation coefficient, for data analysis.

Table 2

Profile of selected hospitals and the number of samples collected by hospitals
Name of Hospital	Number of beds	Number of nurses	Sample size	Distributed questionnaire	Collected questionnaire	Type of hospital
Imam Khomeini hospital complex	1150	1151	148	173	153	General
Children's Medical Center	350	397	51	58	53	Children's Specialized Hospital
Sina	447	439	56	61	55	general
Shariati	495	616	79	88	87	general
Total	2442	2603	334	380	348	-

348 nurses from four selected referral hospitals responded to our questionnaire. Most participating nurses were women (86.2%), 56.3% of them were married and 92.2% had a bachelor's degree. 94% of participants were nurse practitioners, and the rest were supervisors. Type A was the most common blood type (33%). 33% of nurses had less than 10 years’ experience, and 15.8% worked on COVID-19 patients. (Appendix 2)

The average and standard deviation of the MI were (2.42± 0.58) respectively. Among the dimensions of this variable, the highest average is related to EI (3.60 out of 5), and the lowest average is related to IQ (2.87 out of 5). The average and standard deviation of QWL for nurses were (2.42± 0.58) respectively. “Salary” and “job stress” respectively, scored the lowest and highest average among the dimensions of QWL.

The mean and standard deviation of the job performance variable for all nurses was )3.90 ±0.59(, respectively. Among the dimensions of this variable, the dimension of professional ethics showed the highest average, while the contextual dimension with a score of 3.74 had the lowest average (Table 3).

Table 3: Nurses' average scores on managerial intelligence, quality of work life, and job performance

	dimention	minimum	maximum	average	Standard deviation
Managerial Intelligence	emotional intelligence (EI)	0.88	5	3.60	0.68
	political intelligence (PI)	0.75	5	3.29	0.70
	intellectual intelligence (IQ)	0	5	2.87	1.09
	Total: Managerial Intelligence (MI)	1.38	4.83	2.42	0.58
Quality of working life	Participation in the organization	1	5	2.27	0.85
	Job promotion	0.5	4.5	2.25	0.85
	Solving individual problems	1	5	2.28	0.86
	connections	1	4.5	2.62	0.77
	motivation	1	5	2.98	0.83
	Job security	0.5	4.5	2.58	0.72
	salary	1	5	2.06	0.86
	Career pride	0	5	2.73	0.79
	Job stress	1	5	2.99	0.94
	Total: Quality of working life	0.89	4.17	2.42	0.58
job performance	Background	1	5	3.74	0.76
	Professional skill	1.5	5	3.88	0.71
	Clinical skills	2	5	3.99	0.70
	interpersonal communication	1.5	5	3.95	0.75
	Problem Solving	1	5	3.87	0.77
	Ethics	1	5	4.08	0.75
	Teamwork	1	5	3.88	0.74
	leadership	1.5	5	3.83	0.76
	Total: job performance	1.94	5	3.90	0.59

Based on Spearman's correlation coefficient test, only age, work experience and type of employment showed a direct significant correlation with the MI (p<0.05). Job category, income and hospital had a significant correlation with QWL (p<0.05). job performance is closely related to age, blood type, job category, job type and work experience (appendix 3). Spearman’s test also shows a positive significant correlation between MI and job performance (r =0.435, p =0.000), but there is no significant correlation between MI and the QWL (r= -0.020, p = 0.716). Moreover, we found no significant correlation between the QWL and job performance (r= -0.028, p = 0.605).

There was a positive significant relationship between MI and motivation. In addition, the correlation between MI and work stress was significant, yet negative (P<0.05). Further, there was a positive meaningful correlation between job performance with job motivation and career pride. The correlation between job performance with job security, salary and job stress was also negative and significant (P<0.05). There is also positive and significant correlation between all aspects of work performance and MI (P<0.05). In addition, we recorded a negative and significant correlation between QWL and professional skill, clinical skill and professional ethics(P<0.05). There was a positive significant correlation between work performance and all dimensions of MI (P<0.05), as well as between QWL and PI (r=0.135, p=0.012). (Table 4)

Table 4: Correlation between nurses' quality of work life, job performance and managerial intelligence’s dimensions with each other

Our findings indicate that the average MI of nurses was 48.4%. The scores for EI, political intelligence, and intellectual intelligence were 76%, 65.8%, and 57.4%, respectively. The average EI score of 3.60 reflects a high level of emotional competence, while PI was rated at 3.29, and IQ at 2.87, categorizing it as average. Regression analysis revealed that IQ has the most significant impact on overall MI, followed by PI and EI. A research on hospital managers in Sari city- North Iran revealed that 91% of variations in MI could be attributed to IQ and PI, which aligns with our findings[8]. Contrastingly, a study conducted among nurses in an Indonesian hospital suggested that only 20% of performance improvement to IQ, with 80% linked to EQ[11]. We also found that 72% of nurses had high EI. Further, there was a positive and significant correlation between age, work experience, and MI. This can be attributed to exposure to various workplace conditions that enables them to identify key influencers within their profession and effectively engage with them.

Nurses reported an average QWL of 48.4%. This aligns with a study in China which indicate nurses experienced an average QWL[12]. In contrast, one study reported a "relatively favorable" QWL life for nurses[13]. Additionally, an investigation in Bam-South Iran indicated that family doctors enjoy a high average QWL[14]. The diverse and somewhat contradictory findings observed in various research settings can be interpreted in the context of multiple intra-organizational and extra-organizational factors impacting nurses' work life quality [13]. Furthermore, in our study, QWL for nurses is influenced by factors such as occupational category, monthly income, and the specific recruiting hospital. Notably, supervisors reported a higher QWL compared to nurses, and those with higher monthly incomes rated their quality of work life more favorably. Evidence from Bangladeshi hospitals supports the notion that nurses’ quality of work life is significantly impacted by their income and working conditions[15]. Research indicates that organizational characteristics—including management practices, communication dynamics, and available support systems—play a critical role in influencing employees' quality of work life[16].

The average nursing performance indicated a good performance level of 78%. This is consistent with an evaluation conducted in a hospital in Shiraz, South Iran, which highlighted that a significant number of nurses exhibited strong job performance, underscoring the positive outcomes associated with effective management practices and supportive work environments[17]. Additionally, another evaluation of nursing and supervisory performance at a prominent teaching hospital in Tehran revealed an impressive annual performance rate of 90% [18]. Most foreign studies in which nurses' performance has been evaluated by self-evaluation have reported good results[18–20], which might illustrate one of the limits of Self-evaluated questionnaire.

The average job performance of nurses is positively and significantly associated with several factors, i.e., age, blood type, job category, work experience, and employment type. Notably, age was identified as the most influential variable, indicating that older nurses tend to demonstrate enhanced job performance. The type of occupation also significantly affects the nurses’ job performance; those with more stable employment status generally perform better than those in precarious positions. Correlation analyses reveal that as nurses accumulate experience, their competencies in professional skills, problem-solving, interpersonal communication, and relevant background factors improve.

A strong association also exists between job performance and MI among the nurses studied. Despite the absence of a significant relationship between MI and the overall quality of nurses' work life, a noteworthy positive correlation was observed between MI and the motivation aspect of work life quality. Additionally, a significant but negative correlation was found between MI and work-related stress, indicating that nurses with higher MI experience lower levels of workplace stress. A positive and significant correlation also exists between nurses' quality of work life and political intelligence, suggesting that individuals with elevated political intelligence perceive their work life quality more favorably. These findings imply that nurses who possess social awareness and strong networking capabilities are better equipped to navigate institutional power structures, thereby facilitating problem resolution and enhancing their job satisfaction.

It is important to note that we did not find a significant correlation between job performance and quality of work life among nurses. This contrasts with findings from a German study during the COVID-19 pandemic, which reported a connection between nurses' quality of work life and their performance [21]. A Malaysian study reported insignificant relationship between quality of work life and job performance[22]. variations in hospital environments across different countries during the COVID-19 pandemic may account for discrepancies in findings.

Despite the limitations related to QWL, nurses have demonstrated the ability to maintain high levels of job performance, probably attributable to their professional commitment and beliefs. Similarly, the relationships between job performance and QWL dimensions such as job security, salary, and work-related stress—components of QWL—were also found to be significant and negative. This suggests that enhancing nurses' motivation and fostering a sense of pride in their professional roles can lead to improved job performance. This aligns with a Malaysian study that found positive links between both intrinsic and extrinsic motivation with nurses' professional performance[23].

Limitations:

• It is possible that the fear of the effects of the questionnaire results on nurses' future career may have led to possible conservatism and as a result reduced accuracy in completing the questionnaires. If there are documents related to the performance of nurses in hospitals, which have been completed by supervisors, we can have more confidence in the results of the study.
• The number of questions was relatively high. There was a possibility of reducing the accuracy of the nurses in answering the questions. Therefore, in order to solve this obstacle, people were also given enough time so that they could answer the questions in the right time and conditions.
• The research was conducted during the Covid-19 pandemic. This caused the workload of nurses to increase and the mental pressure caused by it. This issue may have affected their perceptions when answering the questions of the questionnaire, especially in the quality of work life section. In order to minimize the effect of this restriction, nurses were given time to complete the questionnaire at their own time and in a relaxed manner.

Policy recommendations:

• Appropriate planning to hold classes to strengthen the social, emotional and political skills of nurses so that their performance improves.
• Considering workshops during their studies before entering the nursing profession.
• Considering nurses' MI when assessing them and specialized competencies of nursing job applicants.
• Creating a positive organizational culture and a better work environment and greater participation of nurses in decision-making to increasing their QWL level.
• Allocating some financial and non-financial incentives to impact the quality of nurses' work life and thus on improving their performance.

Our findings indicated that while nurses exhibited an average level of MI (48.4%), their EI was significantly higher (76%), highlighting the importance of emotional and political intelligence in enhancing job performance. Notably, factors such as age and work experience were positively correlated with MI, suggesting that more experienced nurses possess superior communication and self-management skills. We also identify a significant relationship between MI and job performance, emphasizing the potential for targeted training programs aimed at enhancing both managerial and EI among nursing staff. This underscores the necessity for systemic changes to improve nurses' quality of work life, which is critical for sustaining job performance and overall health system effectiveness.

Overall, a holistic approach that includes improvements in physical working conditions, resource availability, and supportive organizational culture is essential for maximizing the effectiveness and well-being of nursing staff.

HRH Human Resources for Health

QWL Quality of Work Life

MI Managerial Intelligence

EI Emotional Intelligence

IQ Intellectual Intelligence or Intelligence Quotient

PI Political Intelligence

Ethics approval:

This article is based on the first author's MSc. thesis and received ethical approval from the Research Ethics Committees of the School of Public Health & Allied Medical Sciences at Tehran University of Medical Sciences, with the official Ethical Approval ID: IR.TUMS.SPH.REC.1400.136.

Consent for publication:

“Not applicable”

Availability of data and materials:

“Not applicable”

Competing interests:

The authors declare that they have no competing interests.

Funding:

“Not applicable”

Authors' contributions:

FZ.A.: Conceptualization, Methodology, Data gathering, Data Analysis, Writing-original draft.

AM.M.: Methodology, Data Analysis, Writing-reviewing.

A.T.: Conceptualization, Methodology, Writing-original draft, Writing-reviewing and editing.

S.R.: Coordinating field investigations.

Acknowledgements

The authors would like to acknowledge and thank the participants for giving up their time to participate in this study.

Dual publication

The results in this manuscript have not been published elsewhere, nor are they under consideration by another publisher.

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No competing interests reported.

Managerial intelligence, quality of work life and job performance: the experience of nurses in selected public hospitals in Tehran- Iran

Status:

Version 1

Abstract

Background

Methods

Results

Conclusions

Background

Methods

Results

Discussion

Limitations:

Policy recommendations:

Conclusions

Abbreviations

Declarations

References

Additional Declarations

Supplementary Files

Status:

Version 1