The Effects of Emotional Intelligence and the Practice Environment on the Job-Esteem of Physician Assistant Nurses in University Hospitals

Article information

J Korean Acad Fundam Nurs. 2025;32(4):488-496

Publication date (electronic) : 2025 November 30

doi : https://doi.org/10.7739/jkafn.2025.32.4.488

Yoonjung Cho¹⁾, Yeoungsuk Song^2),

¹⁾Nurse, Hanyang University Seoul Hospital, Seoul, Korea

²⁾Professor, College of Nursing, Kyungpook National University, Daegu, Korea

Corresponding author: Song, Yeoungsuk College of Nursing, Kyungpook National University 80 Daehak-ro, Buk-gu, Daegu 41566, Korea Tel: +82-53-950-4483, Fax: +82-53-950-4460, E-mail: asansong@knu.ac.kr

*This article is a condensed form of the first author's master's thesis from Kyungpook National University.

Received 2025 July 24; Revised 2025 September 30; Accepted 2025 November 18.

Abstract

INTRODUCTION

Physician assistant (PA) nurses have played an increasingly vital role in South Korea's healthcare system since the early 2000s by mitigating shortages of essential clinical personnel and partially filling the workload gaps left by medical residents [1-3]. PA nurses often face unclear roles that shift according to hospital needs because they not only provide patient education but may also substitute for interns or residents [4]. Furthermore, their dual affiliation with both nursing and medical departments can create conflicts [4]. The lack of a unified job title, clearly defined practice scope, or standardized education can also hinder the estab-lishment of a strong professional identity [5]. Consequent-ly, many PA nurses report lower perceived professionalism, job satisfaction, and organizational commitment than those in other nursing roles [6,7]. Comprehensive healthcare system reforms involving multisector discussions that demand substantial time and effort are required to address these structural issues [8]. However, fostering positive recognition of their roles, reinforcing their sense of value, and cultivating professional pride may improve job satisfaction, strengthen organizational commitment, and enhance the quality of care delivered by PA nurses [8].

Job-esteem is a relatively new concept that was in-troduced in a study exploring service industry workers’ sense of respect toward their profession (i.e., the personal feelings or perceptions they hold about their job while performing their duties) [8]. Rooted in self-esteem, job-esteem is a psychological concept that involves perceiving and evaluating one's profession [9]. Thus, job-esteem encom-passes individuals’ attitudes, feelings, and emotions toward their occupations. Respect toward and pride in one's work both positively influence self-esteem, which in turn affects respect for and pride in the profession itself [10,11]. For nurses, understanding and enhancing job-esteem positively influences job adaptation, turnover rates, and career management, thereby contributing to effective nursing workforce management and ultimately enabling high-quality patient care [8]. Therefore, to improve PA nurses’ job-esteem, the factors that influence it must first be identified to develop appropriate strategies to address them.

One factor that influences job-esteem is emotional intelligence (EI) [12], which refers to the ability to empathize with one's own and others’ feelings and emotions and uti-lize emotional information to express oneself and appro-priately regulate one's behavior in a given situation [13]. EI has emerged as a core nursing skill, reflecting that nurses provide care by building relationships with patients [14] and frequently face complex interactions with caregivers, medical staff, and collaborating departments. Under such circumstances, managing their emotions can enable PA nurses to improve their conflict resolution, teamwork, and communication skills, reduce job stress, and enhance job satisfaction [15]. Therefore, higher levels of EI are ex-pected to facilitate positive relationships and strengthen emotional regulation, thereby increasing PA nurses’ perceptions of their profession as valuable and respected. Accordingly, examining the relationship between EI and job-esteem in PA nurses is crucial.

The practice environment refers to the organizational characteristics that support the provision of high-quality nursing care in a given environment. It encompasses phys-ical and interpersonal aspects, such as sufficient staffing and resource support, collaborative relationships with medical staff for problem-solving, interpersonal interactions, participation in policy and operational decision-making, delegation of responsibility and autonomy, and professional career development systems [16,17]. A positive practice environment enhances nurses’ professional self-concept and job satisfaction, reduces burnout, and in-creases job-esteem [18,19]. Moreover, a positive practice environment can help nurses recognize their professional value and authority, thereby motivating their career development and increasing their intention to remain in the profession [16,18]. However, PA nurses in South Korea face challenges stemming from the lack of a legal frame-work, which are exacerbated by unclear roles, identity confusion, ambiguous practice scope, lack of educational systems, dual management structures, conflicts with nursing departments, and uncertainty about the future [4]. Thus, improving their practice environment is necessary to enhance the job-esteem of PA nurses, and the relationship between their practice environment and job-esteem must be examined.

Previous studies have examined various aspects related to PA nurses in South Korea, including their perceptions [5]; tasks and operational status [1,2]; role expectations [20]; role experiences [3]; role conflict, job stress, and burnout [7]; work-related hardships [4]; and job satisfaction [15]. However, most of these studies only partially addressed individual variables related to job-esteem, where-as research that investigates EI and the practice environment as antecedent factors influencing job-esteem among PA nurses remains scarce. Recently, the legalization of PA nurses has emerged as a social issue following the February 2024 initiatives, such as pilot projects for clinical support personnel to address the medical gaps caused by Korea's medical resident exodus and physician strikes. This heightened interest highlights the need to improve the poor practice environment faced by PA nurses and un-derstand how this, along with their EI, affects psychological factors, such as job-esteem.

Therefore, this study aimed to investigate the effects of EI and the practice environment on the job-esteem of PA nurses at university hospitals and provide foundational data to enhance their job-esteem. The specific research ob-jectives were to identify 1) the levels of EI, the practice environment, and job-esteem among the participants; 2) differences in job-esteem according to the participants’ general characteristics; 3) the correlations among participants’ EI, the practice environment, and job-esteem; and 4) the effects of EI and the practice environment on participants’ job-esteem.

METHODS

RESULTS

1. General Characteristics

Table 1 presents the participants’ general characteristics. The participants’ mean age was 33.89±5.89 years, with those aged 30∼39 years comprising the largest group, at 56.6% (81 participants). Most participants were women (72.7%, 104 participants). Regarding the highest level of education completed, 75.5% (108 participants) had received a bachelor's degree. The most common current department was surgery (57.3%, 82 participants), followed by other departments (e.g., obstetrics/gynecology and urol-ogy; 25.2%, 36 participants), and internal medicine (17.5%, 25 participants).

Table 1.

General Characteristics and Differences in Job-Esteem (N=143)

Participants’ average work experience as a PA nurse in a university hospital was 5.41±3.73 years, with 46.2% (66 participants) having less than 5 years of experience. Their reasons for choosing position included "avoidance of shift work" (37.1%, 53 participants), "involuntary role assignment" (35.7%, 51 participants), and "pursuit of professional work" (27.2%, 39 participants). When asked if they could take leave time when desired, 84.6% (121 participants) responded "yes." Furthermore, 76.9% (110 participants) reported receiving no prior PA nurse training. Additionally, 81.1% (116 participants) mentioned the lack of regular educational programs related to PA nurse duties, and 70.6% (101 participants) reported the need for documented regulations related to PA nurse roles (Table 1).

2. Emotional Intelligence, the Practice Environment, and Job-Esteem

Table 2 shows the assessment results for the participants’ EI, practice environment, and job-esteem. The mean scores for EI, the practice environment, and job-esteem were 77.01±12.92, 72.01±13.53, and 103.80±13.53, respectively.

Table 2.

Participants’ Emotional Intelligence, Practice Environment, and Job-Esteem (N=143)

4. Correlations Among Emotional Intelligence, the Practice Environment, and Job-Esteem

Table 3 shows the results of the correlation analysis of EI, the practice environment, and job-esteem among PA nurses working at university hospitals. EI had a significant positive correlation with the practice environment (r=.30, p<.001). Significant positive correlations were also observed between job-esteem and both EI (r=.49, p<.001) and the practice environment (r=.52, p<.001).

Table 3.

Correlations among Emotional Intelligence, Practice Environment, and Job-Esteem (N=143)

5. Factors Influencing Job-Esteem

Multiple regression analysis using stepwise selection was conducted to identify the factors influencing participants’ job-esteem. Variables that demonstrated significant differences in job-esteem, such as educational level, reason for choosing position, and ability to take leave time when desired, were included as control variables and dummy-coded. In particular, educational level was dum-my-coded with those with a bachelor's degree as the reference group, and additional dummy variables were created for those with an associate degree or with a master's degree or higher. However, only the associate degree variable was retained in the final stepwise regression analysis. EI and the practice environment showed correlations with job-esteem and were included as independent variables.

The autocorrelation of the dependent variable and multicollinearity among the independent variables were examined before the regression analysis to confirm the ap-propriateness of its use. The Durbin-Watson statistic was 2.15, indicating independence without autocorrelation among the variables. The variance inflation factor values were below 10, ranging from 1.02 to 1.12, and the tolerance limits ranged from .89 to .98, exceeding 0.1. Thus, the variables showed no multicollinearity issues. Residual analysis confirmed that the assumptions of linearity, normality, and homoscedasticity were satisfied, and Cook's distance values did not exceed 1.0, indicating the absence of influential outliers.

The regression analysis revealed that the model was statistically significant (F=32.41, p<.001). Specifically, the practice environment (β=.39, p<.001), EI (β=.36, p<.001), and educational level (associate degree) (β=-.14, p=.04) were found to significantly influence job-esteem. Overall, the model explained 40% of the total variance (Table 4).

Table 4.

Factors Influencing Job-Esteem (N=143)

DISCUSSION

This study assessed the EI and practice environment of PA nurses in university hospitals to determine the factors influencing their job-esteem and provide foundational data for strategies to enhance it. Among the participating PA nurses, the mean EI score was 77.01 points (mean item score: 4.81/7 points). A previous study using the same instrument reported comparable results, with a mean item score of 4.88, suggesting that the EI of PA nurses in Korea is relatively favorable [25]. This consistency across studies indicates that PA nurses tend to demonstrate a moder-ate-to-high level of EI, which may positively contribute to their ability to manage complex clinical tasks.

In this study, participants’ mean practice environment score was 72.01 points (mean item score: 2.48/4 points), which is comparable to the mean item score of 2.67 reported by Ryu et al. [24] for clinical PA nurses working in outpatient clinics and wards of tertiary and general hospitals. This similarity suggests that PA nurses in Korea in different hospital settings may share common practice environment characteristics, such as role ambiguity or limited organizational support.

In this study, participants’ mean job-esteem score was 103.08 points (mean item score: 3.70/5 points). Few studies have specifically examined job-esteem among PA nurses, making direct comparisons difficult. However, a study of nurses in tertiary hospitals using the same instrument reported a mean item score of 3.81 [16], which is comparable to the present findings. Despite differences in roles and responsibilities, the similarity in job-esteem scores between PA and staff nurses may be attributable to their shared professional identity, which is rooted in patient care and specialized expertise and fosters similar levels of professional pride and value.

Correlation analysis showed significant positive correlations between EI and the practice environment, EI and job-esteem, and the practice environment and job-esteem. Few studies have examined the relationships among these variables, specifically in PA nurses, limiting the ability to make direct comparisons. However, the positive correlation between EI and the practice environment observed in this study is consistent with findings from studies conducted among clinical nurses in tertiary hospitals [26]. Similarly, the positive association between EI and job-es-teem aligns with the results of a previous study on cultural tourism interpreters [12]. Although research directly addressing the relationship between EI and job-esteem among PA nurses is lacking, prior studies have demonstrated a positive correlation between EI and the nursing work environment among hospital nurses [16], which supports the findings of this study. These relationships underscore the interdependent nature of individual competen-cies and organizational factors that shape professional attitudes.

The factors found to significantly influence job-esteem were the practice environment, EI, and educational level in this study. Among these factors, the practice environment had the greatest influence on job-esteem. Although studies focusing specifically on PA nurses are limited, these findings are consistent with those of a study on tertiary hospital nurses that identified the practice environment as a key factor affecting job-esteem [16]. The practice environment of nurse practitioners includes professional visibility, relationships with administrators, relationships with medical staff, and independent practice and support [16]. When nurses perceive their organization as recognizing their professional role and engage in positive collabo-rations with medical staff, they are more likely to value their profession and thus demonstrate higher job-esteem [16]. Currently, establishing professionalism among Korean PA nurses would require stronger academic compete-ncies and qualification frameworks [27]. Therefore, hospitals, nursing schools, and professional nursing organizations should make systematic efforts to enhance professionalism by developing structured educational systems and implementing formal certification programs.

EI was identified as the second most influential factor. Although few studies have examined the impact of EI on job-esteem among hospital and PA nurses, a study on cultural tourism interpreters reported similar results, finding that EI influenced social reputation, which is a factor of job-esteem [12]. Furthermore, concept analyses of EI among nurses [28] identified relationally interpreted attributes, such as emotional recognition, regulation, expression, and utilization. These findings suggest that EI can help PA nurses form positive relationships, maintain strong interpersonal connections, and gain social and organizational respect, thereby positively influencing job-esteem. In a mixed-methods study involving 29 newly graduated nurses, an eight-week (20-hour) EI enhancement program was implemented weekly [29]. Although the improvement in EI was not statistically significant, participants in the experimental group reported that the program helped them recognize and regulate their own and others’ emotions, cope with problems more effectively, perceive patients more clearly, and experience positive changes in their practice [29]. The ability to recognize and regulate emotions in clinical contexts is essential for delivering appropriate patient care and may help strengthen all attributes of job-esteem. Therefore, further research is needed to explore programs for PA nurses to enhance their EI and, ultimately, their job-esteem.

Finally, educational level emerged as a significant factor in this study, with nurses holding a bachelor's degree or a master's degree or higher demonstrating greater job-esteem than those with an associate degree. Although research on the relationship between educational level and job-esteem is limited, prior studies have shown that higher education is associated with stronger professional nursing values [30] and better professional self-concept among clinical nurses [31]. These attributes are analogous to job-esteem, thus supporting the findings of this study. In this study, the negative association between holding an associate degree and job-esteem is noteworthy; however, the lack of significant differences in in-house training participation suggests that other forms of education or professional development may be more relevant. These findings indicate that structured academic advancement, such as obtaining higher degrees or pursuing formal certification, may play a more critical role in enhancing job-esteem than short-term in-house training. Moreover, an evaluation program on core fundamental nursing skills conducted among senior nursing students was found to improve professional self-concept [32]. Thus, specialized programs should be developed to enhance PA nurses’ professional knowledge and skills and provide them with such education on a continuous rather than one-time basis.

Overall, PA nurses’ job-esteem was most strongly influenced by their practice environment, EI, and educational level, highlighting the need for strategies to enhance support in the workplace, develop EI, and expand structured educational opportunities.

This study had certain limitations. Recruiting participants from specific hospitals may have limited the repre-sentativeness of the findings. Furthermore, the cross-sectional design precludes causal inferences. Finally, all variables were measured using self-report questionnaires without objective indicators; therefore, the results may be sub-ject to recall or social desirability bias, potentially limiting the accuracy of the assessment.

CONCLUSION

This study found that the most influential factor affecting job-esteem among PA nurses working in university hospitals was the practice environment, followed by EI and educational level. Together, these variables accounted for 40% of the total variance in job-esteem observed in this study. These results suggest that strategies to strengthen PA nurses’ job-esteem should focus on enhancing supportive practice environments, fostering EI, and expanding structured educational opportunities to ultimately promote professional fulfillment, patient care quality, and workforce sustainability. Furthermore, the findings provide a basis for developing and evaluating targeted interventions to strengthen job-esteem in this professional group.

Future studies should be conducted in diverse hospital settings across various regions and incorporate additional variables that could influence job-esteem. In addition, interventions aimed at enhancing PA nurses’ job-esteem need to be developed and systematically evaluated. Finally, lon-gitudinal research designs are recommended to examine causal relationships, and objective performance measures should be included to validate self-reported findings.

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