How Hospital Workplaces Shape Nurses’ Emotional Intelligence in Malaysian Borneo

Emotional intelligence has quietly become one of the most closely watched attributes in modern healthcare. Nurses who can recognize, understand, and regulate emotions, both their own and those of patients and colleagues, tend to communicate better, cope with stress more effectively, and deliver safer, more compassionate care. But where does this emotional skill actually come from? Is it a stable personality trait that nurses simply bring with them to work, or can the hospital environment itself nurture or erode it? A large new study from Sabah, Malaysia, published in BMC Nursing, offers one of the most detailed answers yet, drawing on responses from more than 3,300 registered nurses working in public hospitals and health clinics across the Malaysian state of Borneo.

The research team, led by Norkiah Arsat of Universiti Malaysia Sabah, set out to untangle a question that has puzzled nursing scientists for years: which specific dimensions of the nursing work environment are actually associated with emotional intelligence? Earlier studies had suggested a general link between workplace conditions and emotional competence, but evidence remained thin, particularly in Southeast Asian public healthcare systems where staffing pressures, hierarchical structures, and resource constraints can differ sharply from Western settings. Sabah, with its geographically dispersed hospitals and clinics serving urban and rural communities alike, offered an ideal natural laboratory for probing these relationships at scale.

Methodologically, the study was ambitious. The researchers distributed 4,000 questionnaires to registered nurses across Sabah’s public healthcare facilities, and after careful data screening, 3,359 responses were retained for analysis, an unusually large sample for nursing work environment research. Two validated instruments anchored the survey: the Practice Environment Scale of the Nursing Work Index, which breaks the workplace down into five distinct dimensions, and the Trait Emotional Intelligence Questionnaire Short Form, which captures emotional intelligence across multiple facets including emotional skills, social skills, self-control, and well-being. Rather than treating these constructs as single blobs, the team examined how each workplace dimension related to each emotional intelligence dimension, a granularity that most previous cross-sectional surveys lacked.

To analyze the resulting data, the researchers turned to Partial Least Squares Structural Equation Modelling, or PLS-SEM, a statistical technique increasingly favored in health services research for its ability to test complex networks of relationships between latent constructs, variables that cannot be directly measured but are inferred from multiple survey items. PLS-SEM estimates paths linking predictors to outcomes while accounting for measurement error, and the team supplemented it with checks for reliability, convergent validity through average variance extracted, and composite reliability scores. They also screened for common method variance, the statistical distortion that can arise when all data come from the same self-report instrument, and examined variance inflation factors to rule out problematic multicollinearity among the five workplace dimensions.

The headline finding concerns collegial nurse-physician relations. This dimension, reflecting the quality of collaboration and mutual respect between nurses and doctors, was positively associated with all three global measures of emotional intelligence: emotional skills, social skills, and overall emotional intelligence. In other words, nurses who reported genuinely collaborative relationships with physicians tended to score higher on the emotional competencies that matter most at the bedside. The association was modest in magnitude, the authors caution, but it was consistent across every emotional intelligence outcome tested, making nurse-physician relations the single most broadly connected workplace factor in the entire model.

Two further dimensions showed meaningful positive associations. Nursing foundations for quality care, which captures whether the workplace prioritizes high standards, evidence-based practice, and a culture of excellence in nursing fundamentals, was linked to stronger social skills and higher global emotional intelligence. Similarly, nurse participation in hospital affairs, the degree to which nurses feel their voices count in institutional decision-making, was also positively associated with social skills and global emotional intelligence. Meanwhile, nurse manager ability, leadership and support, reflecting the competence and backing provided by nursing supervisors, was associated with stronger emotional skills and higher global emotional intelligence. Taken together, these findings sketch a coherent picture: workplaces that emphasize quality, inclusion, and supportive leadership tend to be populated by nurses with stronger emotional competencies.

Then came the surprise. Staffing and resource adequacy, the dimension measuring whether there are enough nurses and sufficient resources to do the job properly, showed significant negative associations with every dimension of emotional intelligence. At first glance this seems counterintuitive, since adequate staffing is universally regarded as a cornerstone of good nursing environments. The authors themselves flag the anomaly: supplementary analyses suggested the result may reflect a statistical suppression effect, a phenomenon in which the relationship between two variables is masked or reversed by the influence of a third variable correlated with both. In plain terms, the apparent negative link may be an artifact of the complex intercorrelations among the five workplace dimensions rather than a genuine signal that better-staffed hospitals produce less emotionally intelligent nurses. The researchers urge readers to interpret this particular finding with caution, a refreshingly honest caveat in an era of overconfident headlines.

The study’s strengths and limitations deserve attention. On the plus side, the sheer sample size of 3,359 nurses, the use of validated instruments, the rigorous PLS-SEM framework with cross-validated redundancy checks, and the granular dimension-by-dimension analysis all lend the findings considerable weight. Ethical oversight was thorough, with approval from Malaysia’s Medical Research and Ethics Committee, the Clinical Research Centre, the National Medical Research Register, and the Sabah State Health Director, and written informed consent obtained from every participant. On the other hand, the cross-sectional design means the data capture a single moment in time, so the direction of causality remains unknown. It is entirely plausible that emotionally intelligent nurses perceive their work environments more favorably, rather than, or in addition to, favorable environments cultivating emotional intelligence. The authors also note that the observed associations were generally modest, and they call for longitudinal and post-pandemic studies to clarify both the practical significance and the stability of these relationships, particularly given how profoundly COVID-19 reshaped nursing workloads and morale worldwide.

Why should anyone outside nursing research care? Because emotional intelligence in nurses is not a soft luxury; it is tied to professional functioning, communication quality, and psychological well-being, all of which ripple outward to patient safety and staff retention. If workplace factors such as collaborative nurse-physician relations, genuine participation in hospital affairs, quality-oriented practice cultures, and supportive leadership are indeed associated with stronger emotional competencies, then hospital administrators have concrete, actionable levers to pull. Investing in interdisciplinary teamwork training, creating formal channels for nurse input into policy, and developing nurse managers’ leadership skills may do more than improve job satisfaction; they may help cultivate the emotional infrastructure on which compassionate care depends. Conversely, the study’s cautious stance on staffing suggests that simply adding resources without attending to relational and organizational culture may not deliver the emotional benefits that healthcare systems desperately need.

The Sabah study also carries broader significance for global health workforce research. Most of what is known about nursing work environments and emotional intelligence comes from North America, Europe, and Australia, and findings do not always travel cleanly across cultural and structural contexts. Malaysian public healthcare operates under different hierarchies, staffing models, and professional norms, and demonstrating that similar associations hold in Sabah strengthens the case that the relationship between workplace climate and emotional competence is a general phenomenon rather than a Western artifact. Funded by Universiti Malaysia Sabah’s New Lecturer Grant, the study exemplifies the growing capacity of regional institutions to produce large-scale, methodologically sophisticated evidence about their own health systems. As health systems everywhere grapple with nurse burnout and workforce attrition, the message from Malaysian Borneo is clear and quietly hopeful: the emotional lives of nurses are not fixed traits, and the environments hospitals build around them may matter far more than previously appreciated, provided future longitudinal research confirms which levers truly move the needle.

Subject of Research: Associations between dimensions of the nursing work environment and emotional intelligence among registered nurses in Sabah, Malaysia

Article Title: Associations between the nursing work environment and emotional intelligence among nurses in Sabah, Malaysia

Article References: Arsat, N., Dasan, N., Sator, P., Darsin Singh, S. K., Thomas, D. C., Chong, L. T., Chew-Abdullah, A., Nain, R. A., & Sawatan, W. (2026). Associations between the nursing work environment and emotional intelligence among nurses in Sabah, Malaysia. BMC Nursing. https://doi.org/10.1186/s12912-026-05316-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05316-1

Keywords: nursing, emotional intelligence, work environment, Malaysia, Sabah, PLS-SEM, nurse-physician relations, nursing management, BMC Nursing, cross-sectional study, healthcare workforce, nurse well-being