The Role of Emotional Intelligence in Turnover Intention Among EMS Providers

Main Article Content

Emily Kaplan, DrPH, MPA, EMTP
David Markenson, MD, MBA

Abstract

The Emergency Medical Services are strained in the face of high workforce turnover and substantial cost pressures.  Voluntary workforce turnover exacerbates direct and indirect cost pressures including training, productivity loss, loss of talent, and covering vacancies. Reduction of voluntary turnover is therefore of practical interest for worker retention and cost reduction.  While a robust body of literature is dedicated to exploring precursors of turnover, few studies have explored affective factors leading to turnover emergency medical service clinicians. Key questions investigated are (1) the relationship between trait emotional intelligence (EI) and turnover intention and (2) the relationship between EI and TI controlling for known predictors of turnover intention. A convenience sample (n=446) was obtained through an online survey created with validated EI, turnover, stress and other instruments and distributed to EMS providers via agencies and online forums. Analytic methods include t-tests, Pearson correlations, and linear regression. Higher trait EI was found to result in decreased turnover intention both at the global (r = -.31, p < 0.001) and factor levels (Wellbeing, r = -.22, p< 0.001; Self-Control r = -.19, p < 0.001; Emotionality, r = -.35, p < 0.001; Sociability, r = -.17, p < 0.001). While EI is found to predict turnover intention, other factors such as physical health, perceived stress, and income may be better predictors of turnover intent. Among the important implications of this study is trait EI should be included in discussions of job turnover of EMTs and paramedics, especially in human resource planning. In addition, it highlights that the mental and physical health of EMS clinicians deserves closer attentiveness by researchers, clinicians, policymakers and EMS managers.

Article Details

How to Cite
Kaplan, E., & Markenson, D. (2024). The Role of Emotional Intelligence in Turnover Intention Among EMS Providers. International Journal of Paramedicine, (7), 106–124. https://doi.org/10.56068/UEUI1980
Section
Research Reports

References

Abelson, M. A. (1987). Examination of avoidable and unavoidable turnover. Journal of Applied psychology, 72(3), 382.

Alharthy, N., Alrajeh, O. A., Almutairi, M., & Alhajri, A. (2017). Assessment of anxiety level of emergency health-care workers by generalized anxiety disorder-7 tool. International Journal of Applied and Basic Medical Research, 7(3), 150.

Ali, F., Amorim, I. S., & Chamorro-Premuzic, T. (2009). Empathy deficits and trait emotional intelligence in psychopathy and Machiavellianism. Personality and Individual Differences, 47(7), 758-762.

Andrei, F., & Petrides, K. V. (2013). Trait emotional intelligence and somatic complaints with reference to positive and negative mood. Psihologija, 46(1), 5-15.

Andrei, F., Siegling, A. B., Aloe, A. M., Baldaro, B., & Petrides, K. V. (2016). The Incremental Validity of the Trait Emotional Intelligence Questionnaire (TEIQue): A Systematic Review and Meta-Analysis. In (Vol. 98, pp. 261-276). England: Informa Healthcare.

Avesta Systems Inc., & the American Ambulance Association. (2018). AAA / Avesta 2018 Ambulance Industry Employee Turnover Study.

Baik, S. H., Fox, R. S., Mills, S. D., Roesch, S. C., Sadler, G. R., Klonoff, E. A., & Malcarne, V. L. (2019). Reliability and validity of the Perceived Stress Scale-10 in Hispanic Americans with English or Spanish language preference. Journal of health psychology, 24(5), 628-639.

Bar-On, R. (1997). BarOn emotional quotient inventory: Multi-health systems.

Barzilay, R., Moore, T. M., Greenberg, D. M., DiDomenico, G. E., Brown, L. A., White, L. K., . . . Gur, R. E. (2020). Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers. Translational psychiatry, 10(1), 1-8.

Baudry, A. S., Grynberg, D., Dassonneville, C., Lelorain, S., & Christophe, V. (2018). Sub‐dimensions of trait emotional intelligence and health: A critical and systematic review of the literature. Scandinavian Journal of Psychology, 59(2), 206-222. doi:10.1111/sjop.12424

Bentley, M. A., Crawford, J. M., Wilkins, J. R., Fernandez, A. R., & Studnek, J. R. (2013). An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 17(3), 330-338. doi:10.3109/10903127.2012.761307 [doi]

Bentley, M. A., Mac Crawford, J., Wilkins, J. R., III, Fernandez, A. R., & Studnek, J. R. (2013). An Assessment of Depression, Anxiety, and Stress among Nationally Certified Ems Professionals. In (Vol. 17, pp. 330-338).

Berry, M. L. (2010). Predicting Turnover Intent: Examining the Effects of Employee Engagement, Compensation Fairness, Job Satisfaction, and Age.

Best, S. J., Krueger, B., Hubbard, C., & Smith, A. (2001). An assessment of the generalizability of Internet surveys. Social Science Computer Review, 19(2), 131-145.

Blau, G., Chapman, S., Gibson, G., & Bentley, M. (2011). Exploring the importance of different items as reasons for leaving emergency medical services between fully compensated, partially compensated, and non-compensated/volunteer samples. Journal of allied health, 40(3), 33E-37E.

Bothma, C. F. C., & Roodt, G. (2013). The validation of the turnover intention scale. SA Journal of Human Resource Management, 11(1), 1-12.

Boudreaux, E., Mandry, C., & Brantley, P. J. (1997). Stress, job satisfaction, coping, and psychological distress among emergency medical technicians. Prehospital and Disaster Medicine, 12(4), 9-16.

Bradley, N. (1999). Sampling for Internet surveys. An examination of respondent selection for Internet research. Market Research Society.Journal., 41(4), 1-10.

Bruyneel, L., Thoelen, T., Adriaenssens, J., & Sermeus, W. (2017). Emergency room nurses’ pathway to turnover intention: A moderated serial mediation analysis. Journal of advanced nursing, 73(4), 930-942.

Bureau of Economic, A. BEA Regions
.

Chapman, S. A., Blau, G., Pred, R., & Lopez, A. B. (2009). Correlates of intent to leave job and profession for emergency medical technicians and paramedics. Career Development International.

Cho, S., Johanson, M. M., & Guchait, P. (2009). Employees intent to leave: A comparison of determinants of intent to leave versus intent to stay. International Journal of Hospitality Management, 28(3), 374-381.

Cho, Y. I., Johnson, T. P., & VanGeest, J. B. (2013). Enhancing surveys of health care professionals: a meta-analysis of techniques to improve response. Evaluation & the health professions, 36(3), 382-407.

Cho, Y. J., & Lewis, G. B. (2012). Turnover intention and turnover behavior: Implications for retaining federal employees. Review of Public Personnel Administration, 32(1), 4-23.

Christina, M., Susan, E. J., & Michael, P. L. (1996). Maslach burnout inventory manual. In.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of health and social behavior, 24(4), 385-396.

Cohen, S., Kamarck, T., & Mermelstein, R. (1994). Perceived stress scale. Measuring stress: A guide for health and social scientists, 10.

Doede, M. (2017). Race as a predictor of job satisfaction and turnover in US nurses. Journal of nursing management, 25(3), 207-214.

Edwards, D. L., & Tindle, N. D. (2020). Emotional Exhaustion and its Relationship with Suicide Risk in Emergency Responders. Psychiatry research, 113379.

Enzmann, D., Schaufeli, W., & Girault, N. (1995). The validity of the Maslach Burnout Inventory in three national samples.

Firth, H., & Britton, P. (1989). ‘Burnout’, absence and turnover amongst British nursing staff. Journal of Occupational Psychology, 62(1), 55-59.

Goleman, D. (1995). Emotional intelligence. New York, NY, England: Bantam Books, Inc.

Griffeth, R. W., Hom, P. W., & Gaertner, S. (2000). A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. Journal of management, 26(3), 463-488.

Holtom, B. C., Mitchell, T. R., Lee, T. W., & Eberly, M. B. (2008). 5 turnover and retention research: a glance at the past, a closer review of the present, and a venture into the future. Academy of Management annals, 2(1), 231-274.

Hom, P. W., Lee, T. W., Shaw, J. D., & Hausknecht, J. P. (2017). One hundred years of employee turnover theory and research. Journal of applied psychology, 102(3), 530.

Hong, E., & Lee, Y. S. (2016). The mediating effect of emotional intelligence between emotional labour, job stress, burnout and nurses' turnover intention. International journal of nursing practice, 22(6), 625-632.

Hout, M. (2012). Social and economic returns to college education in the United States. Annual review of sociology, 38, 379-400.

Hruska, P., Hecker, K. G., Coderre, S., McLaughlin, K., Cortese, F., Doig, C., . . . Krigolson, O. (2016). Hemispheric activation differences in novice and expert clinicians during clinical decision making. Advances in Health Sciences Education, 21(5), 921-933. doi:10.1007/s10459-015-9648-3

Huang, G., Chu, H., Chen, R., Liu, D., Banda, K. J., O'Brien, A. P., . . . Chou, K. R. (2022). Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: A meta-analysis. Journal of global health, 12(2047-2986 (Electronic)).

Jones, J. R., & Harter, J. K. (2005). Race effects on the employee engagement-turnover intention relationship. Journal of Leadership & Organizational Studies, 11(2), 78-88.

Jones, S. (1998). Doing Internet research: Critical issues and methods for examining the Net: Sage Publications.

Jordan, P., Shedden-Mora, M. C., & Löwe, B. (2017). Psychometric analysis of the Generalized Anxiety Disorder scale (GAD-7) in primary care using modern item response theory. PloS one, 12(8), e0182162.

Kaplan, E. (2021). Job turnover of EMTs and Paramedics in the US:The impact of emotional intelligence, stress, occupational burnout, and health. (DrPH). New York Medical College, Valhalla, NY. Retrieved from https://touroscholar.touro.edu/nymc_students_theses/17 (17)

Khan, W. A. A., Conduit, R., Kennedy, G. A., & Jackson, M. L. (2020). The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health.

Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. doi:10.1046/j.1525-1497.2001.016009606.x

Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of affective disorders, 114(1-3), 163-173.

Lambert, E. G., Lynne Hogan, N., & Barton, S. M. (2001). The impact of job satisfaction on turnover intent: a test of a structural measurement model using a national sample of workers. The Social Science Journal, 38(2), 233-250.

Leiter, M. P., Jackson, N. J., & Shaughnessy, K. (2009). Contrasting burnout, turnover intention, control, value congruence and knowledge sharing between Baby Boomers and Generation X. Journal of nursing management, 17(1), 100-109. doi:10.1111/j.1365-2834.2008.00884.x [doi]

Leiter, M. P., & Maslach, C. (2009). Nurse turnover: the mediating role of burnout. Journal of nursing management, 17(3), 331-339.

LeVasseur, S. A., Wang, C.-Y., Mathews, B., & Boland, M. (2009). Generational differences in registered nurse turnover. Policy, Politics, & Nursing Practice, 10(3), 212-223.

Loewe, B., Decker, O., Mueller, S., Braehler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical care, 46(3), 266-274.

Lowe, D. J., Ireland, A. J., Ross, A., & Ker, J. (2016). Exploring situational awareness in emergency medicine: developing a shared mental model to enhance training and assessment. Postgraduate medical journal, 92(1093), 653-658. doi:10.1136/postgradmedj-2015-133772

Lum, L., Kervin, J., Clark, K., Reid, F., & Sirola, W. (1998). Explaining nursing turnover intent: job satisfaction, pay satisfaction, or organizational commitment? Journal of Organizational Behavior: The International Journal of Industrial, Occupational and Organizational Psychology and Behavior, 19(3), 305-320.

MacGregor, K. L., Funderburk, J. S., Pigeon, W., & Maisto, S. A. (2012). Evaluation of the PHQ-9 Item 3 as a screen for sleep disturbance in primary care. Journal of general internal medicine, 27(3), 339-344.

Martins, A., Ramalho, N., & Morin, E. (2010). A comprehensive meta-analysis of the relationship between Emotional Intelligence and health. In (Vol. 49, pp. 554-564): Elsevier Ltd.

Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence. Emotional development and emotional intelligence: Educational implications, 3, 31.

McKay, P. F., Avery, D. R., Tonidandel, S., Morris, M. A., Hernandez, M., & Hebl, M. R. (2007). Racial Differences in Employee Retention: are Diversity Climate Perceptions the Key? Personnel Psychology, 60(1), 35-62. doi:10.1111/j.1744-6570.2007.00064.x

Miao, C., Humphrey, R. H., & Qian, S. (2017a). A meta‐analysis of emotional intelligence and work attitudes. Journal of Occupational and Organizational Psychology, 90(2), 177-202.

Miao, C., Humphrey, R. H., & Qian, S. (2017b). Are the emotionally intelligent good citizens or counterproductive? A meta-analysis of emotional intelligence and its relationships with organizational citizenship behavior and counterproductive work behavior. Personality and Individual Differences, 116, 144-156.

Mikolajczak, M., Luminet, O., Leroy, C., & Roy, E. (2007). Psychometric Properties of the Trait Emotional Intelligence Questionnaire: Factor Structure, Reliability, Construct, and Incremental Validity in a French-Speaking Population. Journal of Personality Assessment, 88(3), 338-353. doi:10.1080/00223890701333431

Mikolajczak, M., Luminet, O., & Menil, C. (2006). Predicting resistance to stress: Incremental validity of trait emotional intelligence over alexithymia and optimism. Psicothema, 18, 79-88.

Mikolajczak, M., Menil, C., & Luminet, O. (2007). Explaining the protective effect of trait emotional intelligence regarding occupational stress: Exploration of emotional labour processes. In (Vol. 41, pp. 1107-1117).

Mikolajczak, M., Roy, E., Luminet, O., Fillee, C., & de Timary, P. (2007). The moderating impact of emotional intelligence on free cortisol responses to stress. Psychoneuroendocrinology, 32(8-10), 1000-1012. doi:S0306-4530(07)00196-5 [pii]

Mikolajczak, M., Roy, E., Luminet, O., Fillée, C., & de Timary, P. (2007). The moderating impact of emotional intelligence on free cortisol responses to stress. In (Vol. 32, pp. 1000-1012): Elsevier Ltd.

Mobile Integrated Healthcare and Community Paramedicine (MIH-CP) 2nd National Survey. (2018). Retrieved from Clinton, MS: http://www.naemt.org/docs/default-source/2017-publication-docs/mih-cp-survey-2018-04-12-2018-web-links-1.pdf?Status=Temp&sfvrsn=a741cb92_2

Mobley, W. H., Horner, S. O., & Hollingsworth, A. T. (1978). An evaluation of precursors of hospital employee turnover. Journal of Applied psychology, 63(4), 408.

National Association of State, E. M. S. O. (2020). 2020 National Emergency Medical Services Assessment. Retrieved from https://nasemso.org/wp-content/uploads/2020-National-EMS-Assessment_Reduced-File-Size.pdf

Nelis, D., Quoidbach, J., Mikolajczak, M., & Hansenne, M. (2009). Increasing emotional intelligence:(How) is it possible? Personality and Individual Differences, 47(1), 36-41.

Nosek, B. A., Banaji, M. R., & Greenwald, A. G. (2002). E‐research: Ethics, security, design, and control in psychological research on the Internet. Journal of Social Issues, 58(1), 161-176.

O'Connor, P., Nguyen, J., & Anglim, J. (2017). Effectively coping with task stress: A study of the validity of the Trait Emotional Intelligence Questionnaire–Short Form (TEIQue–SF). Journal of Personality Assessment, 99(3), 304-314.

Osmanovic-Thunström, A., Mossello, E., Åkerstedt, T., Fratiglioni, L., & Wang, H.-X. (2015). Do levels of perceived stress increase with increasing age after age 65? A population-based study. Age and Ageing, 44(5), 828-834.

Panel, E. M. S. A. T. E. (2019). EMS Agenda 2050: A people-Centered Vision for teh Future of Emergency Medical Services. Retrieved from Washington D.C.: https://www.ems.gov/pdf/EMS-Agenda-2050.pdf

Patterson, P. D., Moore, C. G., Sanddal, N. D., Wingrove, G., & LaCroix, B. (2009). Characterizing job satisfaction and intent to leave among nationally registered emergency medical technicians: an analysis of the 2005 LEADS survey. Journal of allied health, 38(3), 84E-91E.

Petrides, K. V. (2009). Technical manual for the Trait Emotional Intelligence Questionnaires (TEIQue) (1 ed.). London, England: London Psychometric Laborotory.

Petrides, K. V. (2010). Trait emotional intelligence theory. Industrial and Organizational Psychology, 3(2), 136-139.

Petrides, K. V., & Furnham, A. (2000). On the dimensional structure of emotional intelligence. In (Vol. 29, pp. 313-320): Elsevier Ltd.

Petrides, K. V., Pita, R., & Kokkinaki, F. (2007). The location of trait emotional intelligence in personality factor space. British Journal of Psychology, 98(2), 273-289. doi:10.1348/000712606X120618

Petrides, K. V., Pérez-González, J. C., & Furnham, A. (2007). On the criterion and incremental validity of trait emotional intelligence. In (Vol. 21, pp. 26-55): Taylor & Francis Ltd.

Pfizer). [Instruction Manual]. Web Page.

Pierannunzi, C., Hu, S. S., & Balluz, L. (2013). A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004-2011. In (Vol. 13, pp. 49). England: BioMed Central.

Rehkopf, L., & Chamberlin, S. (2019). Report to Congress Evaluations of Hospital's Ambulance Data on Medicare Cost Reports and Feasibility of Obtaining Cost Data from All Ambulance Providers and Suppliers. Retrieved from Washington, D.C.:

Ruttledge, R. A., & Petrides, K. V. (2012). A cognitive behavioural group approach for adolescents with disruptive behaviour in schools. School Psychology International, 33(2), 223-239.

Sadler, G. R., Lee, H.-C., Lim, R. S.-H., & Fullerton, J. (2010). Recruitment of hard-to-reach population subgroups via adaptations of the snowball sampling strategy. In Nursing and Health Sciences (Vol. 12, pp. 369-374).

Saintsing, D., Gibson, L. M., & Pennington, A. W. (2011). The novice nurse and clinical decision-making: how to avoid errors. In (Vol. 19, pp. 354-359): John Wiley & Sons, Inc.

Siegling, A. B., Saklofske, D. H., & Petrides, K. V. (2015). Chapter 14 - Measures of Ability and Trait Emotional Intelligence. In (pp. 381-414): Elsevier Inc.

Singh, P., Cumberland, W. G., Ugarte, D., Bruckner, T.-A., & Young, S. D. (2020). Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis. Journal of medical Internet research, 22(9), e21490.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097.

Sporer, C. (2016). Sex differences in Stress, Burnout and Coping in Emergency Medical Service Providers. City University of New York, Retrieved from https://academicworks.cuny.edu/gc_etds/1427 (Dissertation/Thesis)

Thibodeau, M. A., & Asmundson, G. J. G. (2014). The PHQ-9 assesses depression similarly in men and women from the general population. Personality and Individual Differences, 56, 149-153.

U.S. Department of Labor, B. o. L., & Statistics (2020). [EMTs and Paramedics]. Web Page.

U.S. Department of Labor, U. S. B. o. L. S. (2020). Economic News Release: Annual total separations rates by industry and region, not seasonally adjusted. Retrieved from https://www.bls.gov/news.release/jolts.t16.htm

Welzel, F. D., Stein, J., Röhr, S., Fuchs, A., Pentzek, M., Mösch, E., . . . Wiese, B. (2019). Prevalence of anxiety symptoms and their association with loss experience in a large cohort sample of the oldest-old. Results of the AGECODE/AGEQUALIDE study. Frontiers in Psychiatry, 10, 285.

Xu, Y. J. (2008). Gender disparity in STEM disciplines: A study of faculty attrition and turnover intentions. Research in higher education, 49(7), 607-624.