GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 Indonesian Scholars’ Alliance Open Access Research Article Emotional intelligence and transformational leadership: The two factors affecting the nurses’ performance at a general hospital in Bolaang Mongondow Monompia, Kotamobagu, Indonesia Juritno Harmi Gaib*, Fery Mendrofa, Rita Dewi Department of Nursing, Universitas Karya Husada, Semarang, Indonesia *Corresponding author’s e-mail: Harmi.gaib@gmail.com DOI: 10.35898/ghmj-61929 ABSTRACT Background: Emotional intelligence and transformational leadership are two important factors for nurses to be able to motivate themselves and build intra relationships in hospitals, and may affect to the nurses’ performance. Aims: The purpose of the study was to determine how emotional intelligence and leadership affecting the nurses’ performance at the General Hospital of the Evangelical Masehi Church, Bolaang Mongondow Monompia, Kotamobagu, Indonesia Methods: This original research employed an analytic observational with a quantitative approach and a cross sectional study design. A set of questionnaires was distributed to the participated nurses to define the respondents’ characteristics, emotional intelligence (10 questions), leadership transformation (12 questions), and the nurses’ performances (8 questions). A total of 48 nurses were selected in August 2022 using a total sampling technique, and their answers were included to the further statistical analysis using PSS software version 15. Results: Not different with other hospitals, at the Regional General Hospital of Kotamobagu the majority of nurses was female, and relatively has worked for more than 5 years. It has been noted that the nurses were measured with sufficient emotional intelligence (43.8%), transformational leadership (54.1%), and performances (58.3%). However, the number of nurses having poor emotional intelligence and performance were relatively high, respectively at 12.4% and 14.6%. It is indicated that the nurses performance were significantly resulted by the two factors: Emotional intelligence (p-value: 0.025) and transformational leadership (p-value: 0.005). Conclusion: This study concludes that the emotional intelligence and transformational leadership are moderating variables to strengthen the nurses’ performance. This study noted that the higher number of nurses highly perform if having good emotional intelligence and good transformational leadership. Therefore, it is recommended to pay attention to the two strong indicators from this study if a hospital manager plans to improve the nurses’ performance. Keywords: Emotional intelligence, Transformational leadership, Nurse performance. Received: 19 November 2022; Revised: 5 December 2022; Accepted: 31 January 2023 DOI: 10.35898/ghmj-XXXX © Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars’ Alliance). This is an open-access following Creative Commons License Deed - Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) mailto:Harmi.gaib@gmail.com https://doi.org/10.35898/ghmj-61929 https://dx.doi.org/10.35898/ghmj-XXXX 37 GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 Gaib, Mendrofa, & Dewi 1. Introduction Nurses learn to manage their feelings through emotional intelligence so that they can express them appropriately and effectively (McCloughen & Foster, 2018). Nurses in their daily work almost always involve feelings and emotions, so nurses are required to have high emotional intelligence (Soto-Rubio et al., 2020). Hospital nurses in particular need high emotional intelligence because they are the representative the organization to interact with many people both inside and outside the organization (Geun & Park, 2019). Nurses who have empathy will be able to understand the needs of the person or family they are caring for and can provide constructive solutions (Ross et al., 2015). Transformational leadership is a type of leadership that motivates their followers in the direction of established goals by clarifying roles and task guidelines (Sadeghi & Pihie, 2012). Transformational leaders pay attention to the concerns and developmental needs of individual followers; they change followers' awareness of problems by helping them view problems in new ways (Begum et al., 2022). Performance is a real behavior that is produced by everyone as work performance produced by employees in accordance with their role in an organization (Widarko & Anwarodin, 2022). Performance is an accumulation of the quantity, quality and time used in carrying out tasks (Romero & Barbera, 2011). A successful leader is not one who seeks power for himself, but distributes power to many people to achieve common goals (Joullié et al., 2021). Through clarity of authority, responsibility, and balanced with discipline in dealing with problems with employees effectively and efficiently (Tampi et al., 2022). This is also balanced by positive interactions, namely the main skills in managing human resources (Thorn & Jensen, 2022). Leaders must also be sensitive in interacting, both to verbal language, tone of voice, as well as nonverbal or body language (King et al., 2021). The existence of a transformational leader is expected to inspire their followers to go beyond self- interest and who is able to have a deep and extraordinary influence on his followers (Wang et al., 2021). A leader who has a transformational leadership style will be an inspirational figure for his subordinates (Bosak et al., 2021). The ability of the leader as a role model for his subordinates includes in acting, acting, and carrying out work responsibilities (Simorangkir et al., 2021). Proposed four dimensions in a person's level of transformational leadership are namely idealized influence, inspirational motivation, intellectual stimulation, and individual consideration (Tsang et al., 2022). Based on data obtained from the Monompia Hospital GMIBM Kotamobagu in April 2022, it can be seen that the composition of its employees is as follows: Ns 110 nurses, D4 20 people, D3 Dental Nurses 2 and D3 nurses 86 people. Problems obtained from interviews with several hospital service users include lack of friendliness, lack of nurse control over patients, confusion of information about politeness and complaints from the community as users of hospital services, becoming a must for the management to continue to improve performance. The results of a preliminary study in April 2022 found that there were still ± 30 employees who worked as nurses who had not been able to manage their emotions well such as being less friendly in providing services to patients, less caring and rarely conveying the information needed. Therefore, this study aims to determine the effect of emotional intelligence and transformational leadership on the performance of nurses at Monompia Hospital, Kotamobagu. 2. Methods This original research employed an analytic observational with a quantitative approach and a cross sectional study design. This study was aimed to determine the effect of emotional intelligence and leadership on the performance of nurses at the General Hospital Gereja Masehi Injili Bolaang Mongondow Monompia Kotamobagu, Indonesia. Of 56 nurses selected in August 2022 using a total sampling technique based on the data from the human resources division, data from 48 nurses were included to the further statistical analysis. Nurses who did not attend at the time of survey were excluded. A set of questionnaires was distributed to the participated nurses to define the respondents’ characteristics, emotional intelligence (10 questions), leadership transformation (12 questions), and the Gaib, Mendrofa, & Dewi GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 38 nurses’ performances (8 questions). It is important to measure the nurses’ emotional intelligence since it covers the nurses’ ability to recognize their own feelings and the feelings of others, and how the nurses able to motivate themselves and to manage emotions through the instruments. Leadership transformation questionnaire covers a measure of leadership in the form of motivating in carrying out its role as a nurse. Meanwhile, by measuring nurse performance, the authors are able to identify the number of nurses who can provide good service and are able to carry out tasks independently in a timely manner. To measure the variables of Emotional Intelligence (X1), transformational leadership (X2), nurse performance (Y), a set of questionnaire was employed with a measuring instrument Likret scale with alternative answers arranged based on five categories, namely: Strongly Agree (SS), Agree (S), Disagree (KS), Disagree (TS), and Strongly Disagree (STS). In the favorable statement, Strongly Disagree (STS) has a weighted value of 1, Disagree (TS) has a weighted value of 2, Doubtful (RG) has a weighted value of 3, Agree (S) has a weighted value of 4 and strongly agree (SS) has a weighted value of 5. In the unfavorable statement, the answer Strongly Disagree (STS) has a weighted value of 5, Disagree (TS) has a weighted value of 4, doubtful (RG) has a weighted value of 3, Agree (S) has a weight value of 2, and Strongly Agree (SS) has a weight value of 1. The questionnaire in this study has been tested for validity and reliability. In the performance of nurses in hospitals, the r-table value was 0.432 and all questions were declared valid. So, the researchers did not re-validity test because it was standard and valid. On the performance of nurses in hospitals, the Cronbach Alpha value was 0.982, which means high validity or high reliability, so this research is considered reliable and feasible to continue in research. The results of this study were analyzed using univariate and bivariate methods using PSS software version 15. This study is ethically approved by the Universitas Karya Husada Semarang with number 56/BAAK/S2KEP/SA/VII/2022. Data collection has been approved by Department of Health, Regional General Hospital of Kotamobagu with number 445/1351/RSUD-KK/S.Ket/VII/2022. 3. Results Respondent characteristics From Table 1, it is shown that the majority of nurses participated in this study were female (90.4%), aged 25-35 years old (70.8%), graduated from vocational school (90.4%), and relatively senior with length of work more than 5 years (64.6%). Of 48 nurses, the results noted that only 5 male nurses (10.4%) participated in this study. Not only that, it is known that only 10.4% nurses continued their study to bachelor or profession. Table 1. Distribution of respondent in this study Variables (n = 48) Frequency Percent Age (years old) <25 3 5.3 26-35 34 70.8 36-45 9 18.8 >45 2 4.2 Sex Male 5 10.4 Female 43 89.6 Level of Education Diploma 43 89.6 Bachelor/Profession 5 10.4 Length of working <3 years 5 10.4 3-5 years 12 25 >5 years 31 64.6 39 GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 Gaib, Mendrofa, & Dewi Parameter distribution Univariate analysis on the three distributed questionnaires shows that among the 48 nurses working at the General Hospital Gereja Masehi Injili Bolaang Mongondow Monompia Kotamobagu, Indonesia, it has been noted that the majority have sufficient emotional intelligence (43.8%), transformational leadership (54.1%), and performances (58.3%). Even though, there were 2 of 48 nurses measured with poor transformational leadership, from the results we noted that the number of nurses having poor emotional intelligence and performance were relatively high, respectively at 12.4% and 14.6%. Table 2. Distribution all of variables in this study Variables Frequency Percent Emotional intelligence Poor 6 12.4 Enough 21 43.8 Good 21 43.8 Transformational leadership Poor 2 4.2 Enough 20 41.7 Good 26 54.1 Nurse Performance Poor 7 14.6 Enough 13 27.1 Good 18 58.3 Bivariate analysis: Factors affecting the Nurses Performance By a bivariate analysis, we noted how emotional intelligence and transformational leadership style separately affecting the nurses performance at the selected hospital. From Table 3, it is noted the type of emotional intelligence and transformational leadership among the nurses with different performance. The data shows the higher number of nurses highly perform if having good emotional intelligence and good transformational leadership. It is indicated that the nurses performance were significantly resulted by the two factors: Emotional intelligence (p-value: 0.025) and transformational leadership (p-value: 0.005). We can see from the Table 3, of 21 nurses identified with good emotional intelligence, there were 17 nurses (81%) with sufficient performances. In line with that, of 26 nurses measured with good transformational leadership, there were 21 nurses (81%) with good performance. It is suggested that the emotional intelligence and transformational leadership are important variables to strengthen the nurse performance. Table 3. Analysis Bivariate Variable Nurse Performance p-value Poor Enough Good f % f % f % Emotional intelligence Poor 2 33.3 1 16.7 3 50.0 0.025 Enough 3 14.3 10 47.6 8 38.1 Good 2 9.5 2 9.5 17 81.0 Transformational leadership Poor 1 50 0 0 1 50 0.005 Enough 4 57.1 10 50 6 30 Good 2 7.7 3 11.5 21 80 Gaib, Mendrofa, & Dewi GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 40 4. Discussion Based on result of this study shows that the frequency distribution of emotional intelligence is mostly adequate and good (43.8%) and enough (43.8). In line with previous research which found that emotional intelligence is high (good) as much as 90.6% (Misto et al., 2022). Another research said that emotional intelligence has a positive impact on the performance of a nurse (Oktafiani, 2019). The better the emotional intelligence, the higher the performance will be resulted by the nurse (McQueen, 2004). Emotional intelligence is an emotional ability that includes the ability to control oneself, have endurance when facing a problem, be able to control impulses, motivate oneself, be able to regulate moods, be able to empathize and build relationships with others. Emotional intelligence can put a person's emotions in the right portion, sort out satisfaction and regulate moods (Tj et al., n.d.). Mood coordination is at the core of good social relationships (Tan et al., 2022). If someone is good at adjusting to the moods of other individuals or can empathize, that person will have a good emotional level and will more easily adjust to social interactions and the environment (Rangki, 2019). Emotional intelligence is strongly influenced by the environment, is not permanent, can change at any time (Sun et al., 2021). For this reason, the role of the environment, especially parents in childhood, greatly influences the formation of emotional intelligence (Li et al., 2015). The frequency distribution of transformational leadership is mostly good as much as 54.2%. A transformational leader is a leader who is able to inspire his followers to go beyond individual interests and is capable of having a profound and extraordinary influence on his followers. Transformational leadership can provide motivation and inspiration to every employee (Rahim et al., 2020). Transformational leadership seeks to develop the role of employees in a direction that is better and more profitable for employees and can benefit the organization as a whole in terms of increasing organizational productivity. Transformational leadership is a leader who is able to grow in each of his follower’s trust, admiration, loyalty, respect for the leader and motivates to do more than expected (Ribeiro et al., 2018). The leader transforms and motivates followers by making them more aware of the importance of the results of a job, encouraging them to place more importance on the organization or team than self-interest, and activating their needs at a higher level (Hassan et al., 2013). Transformational leaders have certain behavioral components, including integrity and fairness, setting clear goals, having high expectations, providing support and recognition, arousing followers' emotions, and getting people to see things beyond their own self-interest to achieve the impossible (Sadeghi & Pihie, 2012). The distribution of nurse performance is mostly good as much as 58.3%. Nurse performance is a real behavior that is produced by everyone as work performance produced by employees according to their role in an organization. Performance is the quantity, quality and time used in carrying out tasks (Alghamdi, 2016; McCloughen & Foster, 2018). Quantity is a result that can be calculated the extent to which a person can successfully achieve the goals that have been set. A person's performance is related to one's maturity, maturity, and ability at work (McQueen, 2004). Mental maturity and faster rational thinking of nursing, are proves to show the nurses are able to make decisions, wiser, able to control emotions, obey rules and norms and commitment to work (Yosiana et al., 2020). The results of statistical tests using the Chi Square test of the relationship of emotional intelligence to the performance of nurses at Monompia Hospital Kotamobagu obtained p-value: 0.025 (p <0.05). This proves that there is a relationship between emotional intelligence and the performance of nurses. This research is in line with previous research showing that emotional intelligence has a positive and significant effect on employee performance (Amelia & Hersona, 2022). Supported other study with the results of multiple linear regression analysis explains that the variables of self-awareness, self-regulation, motivation, empathy, and social skills have a positive influence on employee performance (Behbahani, 2011; Kaur & Jiwan, 2014). The results of statistical tests using the Chi Square test of the relationship of transformational leadership to the performance of nurses obtained p-value: 0.005 (p <0.05). This proves that there is a 41 GHMJ (Global Health Management Journal) 2023, Vol. 6, No. 1 Gaib, Mendrofa, & Dewi relationship of transformational leadership to the performance. The transformational leadership has a positive and significant effect on nurse performance (Amelia & Hersona, 2022). In line with the other research that the results showed that the transformational leadership style had a positive and significant effect on performance (Murtiningsih, 2017). The transformational leadership supported by emotional intelligence can also improve nurse performance more optimally (Kaslow et al., 2012; McQueen, 2004). The patient safety climate in hospitals is also built through transformational leadership that prioritizes patient safety to reduce unexpected events through supervision (L. C. Hughes et al., 2009; P. Hughes & Ferrett, 2011). An expert in emotional intelligence defines emotional intelligence as the ability to recognize one's own feelings and the feelings of others, the ability to motivate oneself and the ability to manage emotions well in oneself and in relationships with others (Morrison, 2007). The skills in emotional intelligence are divided into personal skills and social skills (Goleman, 2018). Nurses need to recognize the influence of the client's internal and external environment on the client's health and disease conditions. Concepts are relevant to the internal environment including mental and spiritual well-being, and sociocultural beliefs for an individual. While the external environment includes variables of epidemiology, comfort, privacy, safety, cleanliness and an aesthetic environment. Because the client may experience changes from both the internal and external environment, the nurse must assess and facilitate the client's ability to adapt to physical, mental, and emotional changes (Kaslow et al., 2012). 5. Conclusion This study found that the nurses working at the General Hospital Gereja Masehi Injili Bolaang Mongondow Monompia Kotamobagu, Indonesia, were measured with sufficient emotional intelligence (43.8%), transformational leadership (54.1%), and performances (58.3%). However, the number of nurses having poor emotional intelligence and performance were relatively high, respectively at 12.4% and 14.6%. This study noted that the higher number of nurses highly perform if having good emotional intelligence and good transformational leadership. It is indicated that the nurses performance were significantly resulted by the two factors: Emotional intelligence (p-value: 0.025) and transformational leadership (p-value: 0.005). 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Emotional intelligence and transformational leadership: The two factors affecting the nurses’ performance at a general hospital in Bolaang Mongondow Monompia, Kotamobagu, Indonesia. GHMJ (Global Health Management Journal), 6(1), 36–43. https://doi.org/10.35898/ghmj-61929 https://doi.org/10.3390/ijerph17217998 https://doi.org/10.1111/jocn.15548 https://doi.org/10.1186/s12877-021-02632-w https://doi.org/10.18261/nsf.12.2.3 https://doi.org/10.2224/sbp.11041 https://doi.org/10.2224/sbp.9712 https://doi.org/10.52970/grhrm.v2i2.207 https://doi.org/10.31328/jsed.v3i1.1326 https://doi.org/10.35898/ghmj-61929