Impact of work aspects on communication, emotional intelligence and empathy in nursing *

ABSTRACT Objective: to assess the impact of the type of contract and seniority of nursing staff on their attitudes towards communication, emotional intelligence and empathy. Methods: the instruments measuring attitudes towards communication, empathy and emotional intelligence. The study sample was composed of 450 nurses from 7 hospitals. To explore the effect of the variables studied, one-factor ANOVA test, Pearson correlations and hierarchical multiple linear regression models were performed according to the type of contract. Results: there are statistically significant differences between the variables studied according to the type of contract. More specifically, the nursing staff with permanent contract showed higher scores in the cognitive dimension of the scale attitudes towards communication. Likewise, the highest correlations were found among the dimensions of attitudes towards communication in all the groups. At the same time, seniority was positively related to emotional intelligence in the interim and negatively related to empathy in the permanent contract. Finally, regarding the regression models, it was observed that the perspective taken is the main predictor of each dimension of attitudes towards communication in all the groups, regardless of the type of contract. Conclusion: positive working conditions (job security, permanent contract and seniority) have been found to influence the communication skills in the patient-nurse relationship.


Introduction
Interpersonal communication between nurse practitioner and patient is an essential part of health care (1) . The ability to communicate helps in the adherence to treatment and can increase the effectiveness of treatments in primary care (2) . It can also contribute to reducing the emotional distress associated with different diseases (3) , increase disease control, reduce anxiety, improve treatment follow-up, generate realistic expectations, contribute to patient safety, promote self-care and participation (4) , and even prevent malpractice complaints and suits (5) . Despite the importance of the quality of communication with patient, few studies have explored this subject in depth.
Previous reports in the literature have approached this subject considering communication in a general way, but without studying the relation between communication and the specific characteristics of the patient or disease (6) . Communication can be influenced by the knowledge and attitudes of the nurses themselves (7) , the emotional intelligence (EI) and the empathy of the professionals (8) . These variables may act as barriers and/or facilitators, promoting or hindering effective communication with the patient (9) . Overall, studies suggest that nurses who lack EI and empathy do not have the ability to communicate effectively neither with the patient nor with their team (10)(11) .
Few studies have addressed the relationship between attitudes towards communication, EI and empathy (12)(13) . These variables could be influenced by personal or socio-demographic (14) characteristics or conditions of employment, such as seniority or type of contract (15) . In this sense, uncertainty about working conditions (16) , as well as lack of experience of nursing professionals, may increase the levels of stress and tension in the workplace, which could directly affect the communication style of nursing professionals (17)(18) , as well as their empathy and EI. Despite the importance of all these variables, no previous study aiming at analyzing the impact that the working conditions may have on these constructs or how they could relate to each other was found. Therefore, the central objective of this study was to analyze the role that the type of contract and seniority may have in the attitudes towards communication, empathy and EI, as well as in the relationships between these variables in nursing professionals. For this reason, the following hypotheses were raised: H1: People with high level of seniority will exhibit an increased emotional competence; H2: High levels of EI and empathy (see from patient's point of view) will be positively related to the affective dimensions, negatively related to Compassionate Care and Perspective-Taking (JSE); H3: Permanent contracts will give the nurses greater peace of mind and satisfaction, which in turn will modulate the relationship between the remaining variables of the study.

Method
The study was composed of 450 nurses who perform direct patient care from 7 public hospitals in Valencia. After obtaining authorization from the nursing supervisors, an informed consent was obtained from the participants. The nurses filled-out the questionnaires  (19) and translated by the research team.  for nursing students in its original version (19) and it  Table 1).

Discussion
Communication, EI and empathy are necessary skills in nursing care (5,12,16) . Different variables can influence these skills, such as working conditions for The results of the present study partially support hypothesis 1, in which a greater seniority is associated with a greater emotional competence. This association is only observed in emotional attention and standing in patients' shoes, as indicated in previous studies (2) .
Likewise, hypothesis 2 is also partially supported by our ability, both because of their attitude and the current type of training, which gives priority to these aspects (5) .

Conclusion
This study shows how work aspects seem to influence the attitudes towards communication, EI and empathy, as well as the relationships established between them. It has been also found that positive work aspects (job security, permanent contract and seniority) influence the number of emotional skills in the patientnurse relationship.