Journal of Nursing Management, 2013
Nurses’ perceptions of motivational factors: a case study in a Turkish university hospital FILIZ KANTEK
PhD, RN
1
, NEZAKET YILDIRIM
MSN
2
_ and ILKAY KAVLA
MSN
3
Assistant Professor, 2Lecturer and 3Lecturer, Antalya School of Health, Department of Nursing Management, Akdeniz University, Antalya, Turkey. 1
Correspondence Filiz Kantek Antalya School of Health Department of Nursing Management Akdeniz University Antalya Turkey E-mail: [email protected]
_ KANTEK F., YILDIRIM N. & KAVLA I.
(2013) Journal of Nursing Management Nurses’ perceptions of motivational factors: a case study in a Turkish university hospital
Purpose This study investigates the perceptions of nurses regarding work motivation factors. Background Work motivation of nurses is of utmost importance so that patients may receive high-quality and effective nursing services as well as higher levels of care satisfaction. Method This descriptive study was conducted with nurses in a university hospital in Turkey. A personal information form and the motivation factors questionnaire form were used as data collection tools. Data analysis was conducted using mean, ANOVA, t-test, Tukey test and Cronbach’s alpha coefficient. Result Appreciation (mean 4.76) had the highest score among all the factors. It was also found that the respondents’ perceptions regarding motivation varied significantly (P < 0.05) depending on their age, professional experience and institutional experience. No differences were found in the respondents’ perceptions with respect to professional position (P < 0.05). Conclusion The results show that appreciation was perceived as the most effective factor by nurses. Furthermore, nurses’ perception of the influence of motivation factors varied according to age, duration of professional experience and institutional experience. Implications for nursing management Nursing managers can maximise the potential of nurses by implementing appropriate motivation strategies. When developing suitable motivation strategies, they should consider age, duration of professional experience and institutional experience and monitor recent changes. It is strongly recommended that experimental studies are conducted and significant appreciation techniques analysed. Keywords: hospital, motivation, motivation factors, nurse, Turkey Accepted for publication: 24 September 2013
Introduction Work motivation is a key construct to efficiency, quality outcomes and productivity in health care organisations (Harrell 2008). It can be defined as behaviours of individuals on their own accord to achieve a particular goal (Kocßel 2003). Motivation prompts people to take DOI: 10.1111/jonm.12195 ª 2013 John Wiley & Sons Ltd
action to satisfy unmet needs. It signifies a prominent zeal to put effort into achieving a goal or reward to decrease the tension caused by the need (Marquis & Huston 2009). Managerial concerns related to work motivation are not new, but questions concerning motivational incentives, and employees’ perceptions of what motivates them in the workplace continue to be 1
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discussed and analysed (Dunbar 2003, Zydziunaite Katiliute 2007). The purpose of this study was increase understanding and obtain new knowledge factors that affect the motivation of nurses today Turkey.
& to of in
Literature review It has often been stated that the work motivation of nurses is closely related to intention to leave (Tzeng 2002, Yildiz et al. 2009), job satisfaction (Toode et al. 2011) and burnout (Engin & Cam 2009). It has also been noted that higher levels of work motivation significantly increased nurses’ work ability (Camerino et al. 2008). Many studies further demonstrated that employees with higher motivation can potentially have higher levels of professional performance (Filiz 2004, € ßer 2005, Kuvaas 2006). Nevertheless, work motiOlc vation of nurses is of utmost importance in order that patients may receive high-quality and effective nursing services as well as higher levels of satisfaction with € urk 2002). Low work motivation has led to care (Ozt€ a decrease in both service quality and patients’ intention to return for future care, as well as an increase in the cost of patient care (Yildiz et al. 2009). Work motivation is created through the process of individual cognition and consciousness. (Kocßel 2003, Toode et al. 2011). If nurses can formulate their own priorities and evaluate their work-related capabilities, they can more easily find and strengthen the motivating factors for themselves (Toode et al. 2011). However, nurse managers can influence the motivation of nurses by providing efficient feedback that supports growth and productivity (Dunbar 2003). Therefore, managers should investigate employees’ goals, needs and expectations, the reasons that force them to behave in particular ways, and the job environments in order to develop strategies to ensure they maintain € ßer 2005, Karatheir positive attitudes (Kocßel 2003, Olc kaya & Ay 2007). In other words, if we know the factors that stimulate and motivate nurses to do their best at work, our likelihood to develop a better health care service would increase and it might be easier to develop motivation strategies. Motivation factors are generally categorised as economic, psychosocial and € ßer 2005, organisational–managerial (Kocßel 2003, Olc Korkmaz 2008). Economic factors include income, rewards, profit sharing and getting social relief. Psychosocial factors consist of appreciation, status, authority, pension security, independent working and mentoring for others. Organisational–managerial factors refer to opportunities for promotion, job 2
attraction, physical environment, teamwork, and a fair and consistent discipline system. The degree of impact motivation factors have varied in accordance with certain employee requirements and working conditions. While the former includes needs, demands and expectations, the latter defines physical environment, work groups, social facilities and management style (Barutcßugil 2004, Badu 2005). In this study, motivation factors such as income, rewards, participation in profits, social relief, appreciation, having a status, having authority, pension security, independent working, mentoring others, opportunities of promotion, job attraction, physical environment, teamwork and a fair and consistent system of discipline were examined. In Turkey, the work environment has been considered to be highly influential in reducing motivation, especially with regard to lower wages, inadequate equipment and materials, over-long working hours and an excessive number of patients in need of care. Nurses have many different educational levels including high school, associate degree (2-year university), baccalaureate (4-year university) and postgraduate, but all of them have the title of ‘nurse’ and perform the same tasks. In addition, in terms of job security, nurses are employed in permanent (staff) and temporary (contracted) statuses. Job insecurity is a leading source of anxiety for contracted nurses, which eventually leads to a high turnover of these nurses performing the same tasks as the staff (permanent). In Turkey, nurses have various nursing associations (e.g. critical care nurses, manager nurses, emergency nurses and trade unions). However, the ministry of health has a strong influence on professional regulations. Under-employment appears to be a common problem in Turkey, which further complicates the working conditions of the nurses. Because of this, nurses are generally regarded as an occupational group with the lowest job satisfaction and the highest burnout levels among health care workers (Demir et al. 2003, Golbasi et al. 2008, Kocaman et al. 2008). Despite the fact that the work motivation of nurses has been one of the most frequently discussed issues in both national and international nursing literature (Soykenar 2008, Yildiz et al. 2009, Toode et al. 2011), limited empirical evidence has been reported in relation to the factors influencing the work motivation of Turkish nurses. This study therefore aims to investigate the perceptions of nurses regarding their work motivation factors. It further analyses the differences in their perception with regard to a number of personal characteristics, which are assumed to contribute to motivation, job dissatisfaction, intention to leave and burnout of nurses. ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
Methods Participants and setting This descriptive and cross-sectional study was conducted in a university hospital in Antalya, Turkey, which was established in 1981 and still serves as the biggest hospital in the city. The hospital has 755 beds and an International Standards Organisation quality management certificate. This certificate is based on a number of quality management principles, including a strong customer focus, the motivation and implication of top management, the process approach and continual improvement (International Standards Organisation 2013). The hospital senior administration and leadership includes a medical director and, in a hierarchical reporting structure, a hospital director and a director of nursing services. The director of nursing services is only responsible for providing nursing services. All nurses (445 nurses in total), except those on annual leave or sick leave, were included in the study. The data were obtained from 326 nurses. The mean age of nurses was 30.22 6.24 years (minimum 20 years, maximum 59 years), the mean duration of professional experience was 8.44 8.42 years (minimum 1 year, maximum 34 years), the mean duration of institutional experience was 6.29 6.29 years (minimum 1 year, maximum 29 years).
Instruments A personal information form and the motivation factors questionnaire form were used as data collection tools. The former included nine items requesting the respondent’s unit, age, educational status, marital status, the status of having children, duration of professional experience, duration of institutional experience, work shifts and professional position. Korkmaz (2008) designed the motivation factors questionnaire form and tested its reliability. It consists of 15 items on a five-point Likert-type scale (1 = inefficient, 5 = absolutely efficient). The instrument measures a respondent’s perception of motivational factors such as income, rewards, participation in profits, social relief, appreciation, having a status, having authority, pension security, independent working, mentoring others, opportunities for promotion, job attraction, physical environment, teamwork and a fair and consistent system of discipline. Scores of 1, 2, 3, 4 or 5 were given to the responses of ‘absolutely inefficient, ‘inefficient, ‘moderately efficient, ‘efficient’ and ‘absolutely efficient’, respectively. The scores of the items were summed and the total score divided by the number of ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
items, giving a mean score for motivation factors. Therefore, the total minimum score is 1 and the maximum score was 5. Korkmaz (2008) reported a Cronbach’s alpha coefficient of 0.80 for this questionnaire form. In this study, the Cronbach alpha coefficient was 0.91, which indicates a high degree of reliability.
Procedures Before collecting the data, the researchers obtained permission in writing from the institution’s management. All nurses (N = 445) in the hospital were included in the study. However, the researchers could contact only 350 nurses as some were on annual leave (n = 70) or on sick leave (n = 25) during the time when the study was being conducted. The data were collected between May and June 2010. The third author of the study was a director of nursing services in the hospital where the study was conducted. Therefore, the data were collected by the other researchers who handed out the forms in the hospital. Before handing out the forms, the researchers explained the purpose of the study once again and emphasised that the participation was voluntary. The nurses were also asked not to write their names on the forms. It was assumed that the nurses consented to participate if they returned the questionnaire forms. The participants returned 332 forms in total but the researchers had to exclude six of these forms because they were not fully completed and included the remaining 326 forms in the analysis. The response rate was 73.25%.
Data analysis Frequency and percentage distribution and mean analysis were used to describe the demographic variables and motivational factors for the motivation of nurses. Oneway analysis of variance (ANOVA) and Tukey test were used to determine the differences between motivation factors in terms of age, professional experience, institutional experience and work shift. Differences with regard to professional position were analysed with a t-test. Statistical Package for the Social Sciences for Windows 13.0 (SPSS Inc., Chicago, IL, USA) was used in all statistical analyses. In statistical significance testing, P < 0.05 was accepted as statistically significant.
Results In the examination of the respondents’ characteristics (Table 1), all respondents were female and 68.1% of them were baccalaureate graduates. It was also noted 3
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Table 1 The respondents’ characteristics (n = 326) Characteristic Age (years) < 25 25–34 > 35 Educational status Vocational school Associate degree Baccalaureate degree Graduate degree Marital status Married Single Having children No Yes Position Nurse Nurse manager Unit Intensive care Clinic Outpatient Other Professional experience (years) 20 Institutional experience (years) 20 Missing Work shift Day Night Day and night
n
Table 2 Mean scores of motivation factors of nurses (n = 326) %
54 208 64
16.6 63.8 19.6
14 84 222 6
4.3 25.8 68.1 1.8
193 134
59.0 41.0
175 151
53.6 46.4
297 30
90.8 9.2
81 160 36 50
24.8 48.9 11.0 15.3
122 76 78 20 30
37.4 23.3 23.9 6.2 9.2
168 72 47 14 14 11
51.5 22.1 14.4 4.3 4.3 3.4
87 27 212
26.7 8.3 65.0
that 59.0% of the participants were married and 53.6% of the nurses had no children. The majority (90.8%) of the participants were staff nurses and 65.0% of nurses worked in day and night work shifts. The descriptive statistic (i.e. mean, SD) and percentage distributions of the nurses’ perceptions about motivation factors are illustrated in Table 2. An analysis of the mean scores of motivation factors concluded that nurses perceived all motivation factors as influential on their work motivation. However, appreciation (mean = 4.76, SD = 0.500), rewards (mean = 4.69, SD = 0.532) and pension security (mean = 4.68, SD = 0.601) had the highest scores, respectively. The distribution of motivation factors according to age groups are presented in Table 3. The respondents’ perceptions in different age groups regarding status (P = 0.003), authority (P = 0.007), demand for advice 4
Motivation factor
Mean
SD
Effective, %
Partially effective, %
Ineffective, %
Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
4.61 4.69 4.63
0.617 0.532 0.624
96.6 98.8 95.7
2.5 0.6 2.5
0.9 0.6 1.8
4.22 4.76 4.54 4.60 4.68 4.43
0.901 0.500 0.677 0.638 0.601 0.788
80.9 98.5 94.5 95.8 97.3 91.5
13.5 0.6 3.1 2.8 1.5 5.8
5.5 0.9 2.4 1.5 1.2 2.7
4.51 4.57
0.636 0.641
96.4 96.3
2.1 1.8
1.5 1.8
4.33 4.59
0.850 0.653
87.4 95.1
8.3 2.8
4.5 2.1
4.52 4.57
0.650 0.745
93.5 93.6
5.8 3.4
0.9 3.0
(P = 0.014), opportunities of promotion (P = 0.009) and physical environment (P = 0.000) were significantly different. Those respondents who were 24 years old or younger and respondents who were 25–34 years old reported higher scores than the other age groups. The scores of motivation factors were also studied with regard to duration of professional experience (Table 4). Depending on the respondents’ duration of professional experience, statistically significant differences were found on perceptions regarding rewards (P = 0.039), status (P = 0.000), authority (P = 0.000), pension security (P = 0.028), independent working (P < 0.007), mentoring for others (P = 0.000), opportunities of promotion (P = 0.000) and physical environment (P = 0.000). Nurses with a professional experience of 5 years or less and 5–10 years reported consistently higher scores than the other groups, except the motivational factor on pension security. The respondents with a professional experience of 10–14 years reported the lowest scores for pension security (mean = 4.53, SD = 0.681). Depending on the respondents’ institutional experience, statistically significant differences were found regarding perceptions of status (P = 0.002) and physical environment (P = 0.005) as motivational factors. Those respondents whose professional experience was 5 years or less reported much higher scores than the other respondents (status: mean = 4.67, SD = 0.596; physical environment: mean = 4.70, SD = 0.653) (Table 5). ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
Table 3 Scores of motivation factors and respondents’ age (n = 326) Age (years) Motivation factor Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
< 25 (n = 54) Mean (SD) 4.59 4.76 4.57 4.26 4.80 4.69 4.74 4.65 4.54 4.69 4.69 4.44 4.78 4.57 4.63
25–34 (n = 208) Mean (SD)
(0.790) (0.642) (0.815) (0.894) (0.528) (0.577) (0.589) (0.649) (0.862) (0.507) (0.696) (0.984) (0.634) (0.662) (0.784)
4.64 4.69 4.69 4.22 4.77 4.57 4.63 4.69 4.43 4.51 4.61 4.36 4.62 4.51 4.57
> 35 (n = 64) Mean (SD)
(0.573) (0.484) (0.559) (0.919) (0.474) (0.641) (0.568) (0.567) (0.753) (0.606) (0.554) (0.817) (0.610) (0.682) (0.733)
4.50 4.61 4.58 4.16 4.69 4.30 4.39 4.63 4.31 4.34 4.36 4.16 4.33 4.55 4.48
(0.591) (0.581) (0.638) (0.859) (0.560) (0.810) (0.828) (0.525) (0.833) (0.781) (0.804) (0.821) (0.736) (0.532) (0.756)
F
P
1.320 1.182 1.232 0.201 0.881 5.799 5.080 0.228 1.202 4.305 4.797 1.945 7.950 0.223 0.580
0.269 0.308 0.293 0.818 0.415 0.003* 0.007* 0.796 0.302 0.014* 0.009* 0.145 0.000* 0.800 0.561
*P 15 (n = 50) Mean (SD) 4.50 4.60 4.58 4.18 4.70 4.26 4.42 4.64 4.34 4.32 4.32 4.14 4.30 4.58 4.48
(0.614) (0.606) (0.642) (0.850) (0.580) (0.853) (0.859) (0.693) (0.848) (0.844) (0.844) (0.808) (0.763) (0.538) (0.814)
F
P
0.767 2.817 1.852 0.993 1.735 7.455 7.478 3.065 4.082 7.700 6.708 1.895 6.241 1.000 0.572
0.513 0.039* 0.138 0.396 0.160 0.000* 0.000* 0.028* 0.007* 0.000* 0.000* 0.130 0.000* 0.393 0.634
*P < 0.05.
The perceptions regarding the motivational factors were also analysed between the professional position groups. No statistically significant differences were found (P < 0.05).
Discussion Work motivation is essential for enhancing the professional roles of nurses, strengthening the professional image, improving the health care system and increasing the quality of care and health of the individual and community (Oshvandi et al. 2008). It is crucial to grasp the influence of motivation factors in order to ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
develop effective motivation strategies (Kocßel 2003, Filiz 2004, Robbins 2004). This study specifically focused on the perceptions of nurses regarding the motivational factors in their work. The findings demonstrated that the motivational factors were different and varied in terms of the respondents’ age group, professional position, duration of professional and institutional experience. The findings of the study acknowledge that nurses perceive appreciation as the most effective factor in work motivation and the influence of motivation factors varies with age, duration of professional experience and duration of institutional experience. 5
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Table 5 Scores of motivation factors and respondents’ institutional experience (n = 315) Institutional experience (years) Motivation factor Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
< 5 (n = 168) Mean (SD) 4.67 4.75 4.72 4.32 4.80 4.67 4.68 4.70 4.49 4.60 4.64 4.40 4.70 4.54 4.57
(0.652) (0.522) (0.608) (0.887) (0.496) (0.596) (0.560) (0.575) (0.797) (0.549) (0.604) (0.884) (0.653) (0.708) (0.808)
5–9 (n = 72) Mean (SD) 4.56 4.61 4.60 4.10 4.79 4.47 4.51 4.69 4.39 4.43 4.57 4.29 4.56 4.54 4.61
(0.554) (0.571) (0.685) (0.906) (0.502) (0.731) (0.769) (0.642) (0.881) (0.784) (0.709) (0.830) (0.579) (0.555) (0.545)
10–14 (n = 47) Mean (SD) 4.62 4.66 4.53 4.15 4.64 4.43 4.55 4.57 4.30 4.40 4.49 4.26 4.43 4.40 4.60
(0.491) (0.479) (0.620) (0.859) (0.529) (0.715) (0.653) (0.715) (0.689) (0.648) (0.655) (0.793) (0.683) (0.681) (0.648)
>15 (n = 28) Mean (SD) 4.36 4.64 4.50 3.96 4.68 4.21 4.54 4.64 4.43 4.39 4.39 4.11 4.32 4.64 4.32
(0.678) (0.488) (0.577) (0.999) (0.476) (0.686) (0.508) (0.488) (0.504) (0.497) (0.497) (0.875) (0.723) (0.488) (0.983)
F
P
2.375 1.393 2.052 2.037 1.583 5.127 1.632 0.596 0.824 2.382 1.617 1.221 4.365 0.880 1.099
0.070 0.245 0.107 0.109 0.193 0.002* 0.182 0.618 0.481 0.070 0.185 0.302 0.005* 0.451 0.350
*P < 0.05.
Appreciation for employees is an important tool for recognition. Appreciated employees feel their work is being noticed, their efforts are valued by others and they feel that they themselves are important (Ellis & Hartley 2005, Abualrub & Al-Zaru 2008, ). Concurring with the findings of our study, previous studies on efficient motivation factors for nurses revealed that appreciation is the leading motivation factor for nurses, (Joshua-Amadi 2002, Karakaya & Ay 2007). A similar kind of study was conducted with health care professionals in Mali and the findings demonstrated that the main motivation factors of health workers were related to responsibility, training, recognition and salary (Dieleman et al. 2003). However, many studies on work motivation have indicated that appreciation by superiors and leaders is highly motivating for workers (Dye 2000, Dieleman et al. 2003, Polyzos et al. 2006, Willis-Shattuck et al. 2008). In Turkey, most of the first-level managers in hospitals are physicians; nurses are represented as secondor third-level managers. Hospitals often have a power culture and autocratic management style. Thus, physicians and other managers are dominant over nurses. Further, nurses are generally seen as physicians’ subordinates and they may be considered as unqualified professionals. The authority and expertise of nurses for clinical decision-making is not recognised (Kaya 2007, Can 2008, Golbasi et al. 2008). Therefore, the fact that nurses perceived appreciation as the most influential factor on their work motivation may be considered as a consequence of the need for attention from others. The study results emphasised that there were differences in the nurses’ perception of motivation factors 6
related to age, professional experience and institutional experience. Status, authority, mentoring others, opportunities for promotion and physical environment were found to be efficient motivators for those aged 24 years or less and 25- to 34-year-old nurses, while rewards, status, authority, independent working, mentoring others and opportunities for promotion were more promising motivation factors for those with professional experience of 5 years or less and 5–10 years. In addition, status and physical environment were occasionally reported as major sources of motivation for nurses with a professional experience of 5 years or less. In other words, certain motivation factors proved to be more influential for younger and comparatively less experienced nurses. These findings were found consistent with those of previous studies. Soykenar (2008) conducted a study in Turkey with health care providers in a university hospital and confirmed that the personnel in the younger age ranges (18–24 years and 25–34 years) and with a professional experience of 5 years or less considered some motivation factors as more effective. A study in USA, Smerek and Peterson (2007) reported that there was a negative correlation between some motivation factors and duration of professional experience and age. Another study in Australia found that the younger group (30 years old and younger) perceived intrinsic motivation factors as comparatively more significant (McCabe et al. 2005). The results suggest that younger and relatively less experienced nurses with an institutional experience of 5 years or less perceived certain motivation factors such as status, authority, mentoring others, opportunities for promotion and physical environment as more ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
influential, which can be explained by their short career in professional life. The study results also confirmed that nurse managers should take age, professional experience and institutional experience into account in designing motivation strategies, which will assist them in attaining greater success in enhancing motivation. Thus, it will enable the management to efficiently utilise limited institutional resources (e.g. time, human resources and money) and to enhance the motivation of their staff.
Methodological issues and study limitations Certain limitations should be considered in the evaluation of the study results. The study investigated the perceptions of nurses in only one university hospital. That choice was intentional because the nursing services director of the hospital was among the authors and she had been planning initiatives that might promote the motivation of the nurses in her hospital. This particular study, therefore, was partly designed to provide data and a baseline measurement for those initiatives. Consequently, it is not possible to generalise the study results to nurses and/or health care providers in other hospitals in Turkey. The nurses’ perceptions of motivational factors are also limited to the factors that were measured by using the motivation factors questionnaire form.
2009). Therefore, nursing managers need to recognise each worker as a unique individual motivated by different needs. Nursing managers are expected to take certain characteristics of their employees into serious consideration, such as age, duration of professional experience and institutional experience while designing their motivation strategies and they should plan follow-up and modifications in these characteristics. In addition, as motivation factors are susceptible to change (Kocßel 2003), it may be practical to study perceptions of nurses at certain intervals. It is recommended that this study be conducted with a larger sample in future to enable the researchers to generalise the results. It is also considered useful to conduct a comparative study with nurses from different institutions (e.g. public hospitals, university hospitals and private hospitals) in order to gather additional data about the nurses’ choice of motivation factors. In addition, it would be most beneficial to carry out experimental studies to analyse leading factors and investigate the techniques of appreciation that influence the motivation of nurses.
Acknowledgement This study was supported by Akdeniz University Scientific Research Projects Unit.
Conclusion This particular study dealt with motivation factors for nurses. The results showed that appreciation was the leading factor. In addition, motivation factors for nurses varied according to age, duration of professional experience and duration of institutional experience. It was further noted that those with different perceptions towards motivation factors were younger and relatively less experienced nurses with an institutional experience of 5 years or less. Moreover, status, authority, opportunities for promotion and physical environment were commonly perceived differently.
Implications for nursing management Work motivation is an extremely relevant factor that influences the quality and content of work-related outcomes in health care (Toode et al. 2011). Motivation comes from within the person and managers cannot directly motivate subordinates. However, managers can maximise the potential of their employees with appropriate motivation strategies. All employees have some needs to motivate them (Marquis & Huston ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Source of funding Funding was not provided for this research project.
Ethical approval Ethical approval was not required for this paper.
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€ in Hospitals: A Case Study]. C g Universitesi Sosyal Bilimler ß a Enstit€ us€ u Y€ uksek Lisans Tezi, Mersin. Kuvaas B. (2006) Work performance, affective commitment, and work motivation: the roles of pay administration and pay level. Journal of Organizational Behavior 27 (3), 365– 385. Marquis B.L. & Huston C.J. (2009) Leadership Roles and Management Functions in Nursing, 6th edn. Lippincott Williams & Wilkins, Philadelphia, PA. McCabe R., Nowak M. & Mullen S. (2005) Nursing careers: what motivated nurses to choose their profession? Australian Bulletin of Labour 31 (4), 384–406. € ßer F. (2005) Departmanlı Ma € Olc gazalarda Motivasyon Uzerine
Bir Arasßtırma [A Study on Motivation in Department Stores]. € _ _ Erciyes Universitesi Iktisadi ve Idari Bilimler Fak€ ultesi Dergisi 25, 1–26. Oshvandi K., Zamanzadeh V., Ahmadi F., Fathi-Azar E., Anthony D. & Harris T. (2008) Barriers to nursing job motivation. Research Journal of Biological Sciences 3 (4), 426–434. € urk H. (2002) Hemsßirelerin Motivasyon D€ Ozt€ uzeyleri ve Performans D€ uzeyleri [Nurses’ Motivation Levels and Perfor€ mance Levels]. Doctorate thesis. Istanbul Universitesi Sa glık _ Bilimleri Enstit€ us€ u, Istanbul. Polyzos N., Mylonakis J. & Yfantopoulos J. (2006) An empirical evaluation of employees’ job satisfaction in public private hospitals in Greece. European Journal of Social Sciences 2 (2), 160–176. Robbins S.P. (2004) Essentials of Organizational Behavior, 8th edn. Pearson Prentice Hall, Upper saddle River, NJ. Smerek R.E. & Peterson M. (2007) Examining Herzberg’s Theory: improving job satisfaction among non-academic employees at a university. Research in Higher Education 48 (2), 229–250. _ ßletmelerinde Personelin MotivSoykenar M. (2008) Sag˘lık Is € asyonunu Etkileyen Fakto¨rler: Dokuz Eyl€ ul Universitesi Has¨ rnek Bir Uygulama [Variables That Affect the tanesinde O Motivation of Health Care Providers in Health Organizations: A Case Study in Dokuz Eylul University Hospital]. Dokuz Eylu¨l U¨niversitesi Sosyal Bilimler Enstitu¨su¨ Y€ uksek _ Lisans Tezi, Izmir. Toode K., Routasalo P. & Suominen T. (2011) Work motivation of nurses: a literature review. International Journal of Nursing Studies 48, 246–257. Tzeng H. (2002) The influence of nurses’ working motivation and job satisfaction on intention to quit: an empirical investigation in Taiwan. International Journal of Nursing Studies 39 (8), 867–878. Willis-Shattuck M., Bidwell P., Thomas S., Wyness L., Blaauw D. & Ditlopo P. (2008) Motivation and retention of health workers in developing countries: a systematic review. BMC Health Services Research 8, 247–255. Yildiz Z., Ayhan S. & Erdo gmus S. (2009) The impact of nurses’ motivation to work, job satisfaction, and sociodemographic characteristics on intention to quit their current job: an empirical study in Turkey. Applied Nursing Research 22 (2009), 113–118. Zydziunaite V. & Katiliute E. (2007) Improving motivation among health care workers in private health care organizations: a perspective of nursing personnel. Baltic Journal of Management 2 (2), 213–224.
ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Nurses’ perceptions of motivational factors: a case study in a Turkish university hospital FILIZ KANTEK
PhD, RN
1
, NEZAKET YILDIRIM
MSN
2
_ and ILKAY KAVLA
MSN
3
Assistant Professor, 2Lecturer and 3Lecturer, Antalya School of Health, Department of Nursing Management, Akdeniz University, Antalya, Turkey. 1
Correspondence Filiz Kantek Antalya School of Health Department of Nursing Management Akdeniz University Antalya Turkey E-mail: [email protected]
_ KANTEK F., YILDIRIM N. & KAVLA I.
(2013) Journal of Nursing Management Nurses’ perceptions of motivational factors: a case study in a Turkish university hospital
Purpose This study investigates the perceptions of nurses regarding work motivation factors. Background Work motivation of nurses is of utmost importance so that patients may receive high-quality and effective nursing services as well as higher levels of care satisfaction. Method This descriptive study was conducted with nurses in a university hospital in Turkey. A personal information form and the motivation factors questionnaire form were used as data collection tools. Data analysis was conducted using mean, ANOVA, t-test, Tukey test and Cronbach’s alpha coefficient. Result Appreciation (mean 4.76) had the highest score among all the factors. It was also found that the respondents’ perceptions regarding motivation varied significantly (P < 0.05) depending on their age, professional experience and institutional experience. No differences were found in the respondents’ perceptions with respect to professional position (P < 0.05). Conclusion The results show that appreciation was perceived as the most effective factor by nurses. Furthermore, nurses’ perception of the influence of motivation factors varied according to age, duration of professional experience and institutional experience. Implications for nursing management Nursing managers can maximise the potential of nurses by implementing appropriate motivation strategies. When developing suitable motivation strategies, they should consider age, duration of professional experience and institutional experience and monitor recent changes. It is strongly recommended that experimental studies are conducted and significant appreciation techniques analysed. Keywords: hospital, motivation, motivation factors, nurse, Turkey Accepted for publication: 24 September 2013
Introduction Work motivation is a key construct to efficiency, quality outcomes and productivity in health care organisations (Harrell 2008). It can be defined as behaviours of individuals on their own accord to achieve a particular goal (Kocßel 2003). Motivation prompts people to take DOI: 10.1111/jonm.12195 ª 2013 John Wiley & Sons Ltd
action to satisfy unmet needs. It signifies a prominent zeal to put effort into achieving a goal or reward to decrease the tension caused by the need (Marquis & Huston 2009). Managerial concerns related to work motivation are not new, but questions concerning motivational incentives, and employees’ perceptions of what motivates them in the workplace continue to be 1
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discussed and analysed (Dunbar 2003, Zydziunaite Katiliute 2007). The purpose of this study was increase understanding and obtain new knowledge factors that affect the motivation of nurses today Turkey.
& to of in
Literature review It has often been stated that the work motivation of nurses is closely related to intention to leave (Tzeng 2002, Yildiz et al. 2009), job satisfaction (Toode et al. 2011) and burnout (Engin & Cam 2009). It has also been noted that higher levels of work motivation significantly increased nurses’ work ability (Camerino et al. 2008). Many studies further demonstrated that employees with higher motivation can potentially have higher levels of professional performance (Filiz 2004, € ßer 2005, Kuvaas 2006). Nevertheless, work motiOlc vation of nurses is of utmost importance in order that patients may receive high-quality and effective nursing services as well as higher levels of satisfaction with € urk 2002). Low work motivation has led to care (Ozt€ a decrease in both service quality and patients’ intention to return for future care, as well as an increase in the cost of patient care (Yildiz et al. 2009). Work motivation is created through the process of individual cognition and consciousness. (Kocßel 2003, Toode et al. 2011). If nurses can formulate their own priorities and evaluate their work-related capabilities, they can more easily find and strengthen the motivating factors for themselves (Toode et al. 2011). However, nurse managers can influence the motivation of nurses by providing efficient feedback that supports growth and productivity (Dunbar 2003). Therefore, managers should investigate employees’ goals, needs and expectations, the reasons that force them to behave in particular ways, and the job environments in order to develop strategies to ensure they maintain € ßer 2005, Karatheir positive attitudes (Kocßel 2003, Olc kaya & Ay 2007). In other words, if we know the factors that stimulate and motivate nurses to do their best at work, our likelihood to develop a better health care service would increase and it might be easier to develop motivation strategies. Motivation factors are generally categorised as economic, psychosocial and € ßer 2005, organisational–managerial (Kocßel 2003, Olc Korkmaz 2008). Economic factors include income, rewards, profit sharing and getting social relief. Psychosocial factors consist of appreciation, status, authority, pension security, independent working and mentoring for others. Organisational–managerial factors refer to opportunities for promotion, job 2
attraction, physical environment, teamwork, and a fair and consistent discipline system. The degree of impact motivation factors have varied in accordance with certain employee requirements and working conditions. While the former includes needs, demands and expectations, the latter defines physical environment, work groups, social facilities and management style (Barutcßugil 2004, Badu 2005). In this study, motivation factors such as income, rewards, participation in profits, social relief, appreciation, having a status, having authority, pension security, independent working, mentoring others, opportunities of promotion, job attraction, physical environment, teamwork and a fair and consistent system of discipline were examined. In Turkey, the work environment has been considered to be highly influential in reducing motivation, especially with regard to lower wages, inadequate equipment and materials, over-long working hours and an excessive number of patients in need of care. Nurses have many different educational levels including high school, associate degree (2-year university), baccalaureate (4-year university) and postgraduate, but all of them have the title of ‘nurse’ and perform the same tasks. In addition, in terms of job security, nurses are employed in permanent (staff) and temporary (contracted) statuses. Job insecurity is a leading source of anxiety for contracted nurses, which eventually leads to a high turnover of these nurses performing the same tasks as the staff (permanent). In Turkey, nurses have various nursing associations (e.g. critical care nurses, manager nurses, emergency nurses and trade unions). However, the ministry of health has a strong influence on professional regulations. Under-employment appears to be a common problem in Turkey, which further complicates the working conditions of the nurses. Because of this, nurses are generally regarded as an occupational group with the lowest job satisfaction and the highest burnout levels among health care workers (Demir et al. 2003, Golbasi et al. 2008, Kocaman et al. 2008). Despite the fact that the work motivation of nurses has been one of the most frequently discussed issues in both national and international nursing literature (Soykenar 2008, Yildiz et al. 2009, Toode et al. 2011), limited empirical evidence has been reported in relation to the factors influencing the work motivation of Turkish nurses. This study therefore aims to investigate the perceptions of nurses regarding their work motivation factors. It further analyses the differences in their perception with regard to a number of personal characteristics, which are assumed to contribute to motivation, job dissatisfaction, intention to leave and burnout of nurses. ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
Methods Participants and setting This descriptive and cross-sectional study was conducted in a university hospital in Antalya, Turkey, which was established in 1981 and still serves as the biggest hospital in the city. The hospital has 755 beds and an International Standards Organisation quality management certificate. This certificate is based on a number of quality management principles, including a strong customer focus, the motivation and implication of top management, the process approach and continual improvement (International Standards Organisation 2013). The hospital senior administration and leadership includes a medical director and, in a hierarchical reporting structure, a hospital director and a director of nursing services. The director of nursing services is only responsible for providing nursing services. All nurses (445 nurses in total), except those on annual leave or sick leave, were included in the study. The data were obtained from 326 nurses. The mean age of nurses was 30.22 6.24 years (minimum 20 years, maximum 59 years), the mean duration of professional experience was 8.44 8.42 years (minimum 1 year, maximum 34 years), the mean duration of institutional experience was 6.29 6.29 years (minimum 1 year, maximum 29 years).
Instruments A personal information form and the motivation factors questionnaire form were used as data collection tools. The former included nine items requesting the respondent’s unit, age, educational status, marital status, the status of having children, duration of professional experience, duration of institutional experience, work shifts and professional position. Korkmaz (2008) designed the motivation factors questionnaire form and tested its reliability. It consists of 15 items on a five-point Likert-type scale (1 = inefficient, 5 = absolutely efficient). The instrument measures a respondent’s perception of motivational factors such as income, rewards, participation in profits, social relief, appreciation, having a status, having authority, pension security, independent working, mentoring others, opportunities for promotion, job attraction, physical environment, teamwork and a fair and consistent system of discipline. Scores of 1, 2, 3, 4 or 5 were given to the responses of ‘absolutely inefficient, ‘inefficient, ‘moderately efficient, ‘efficient’ and ‘absolutely efficient’, respectively. The scores of the items were summed and the total score divided by the number of ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
items, giving a mean score for motivation factors. Therefore, the total minimum score is 1 and the maximum score was 5. Korkmaz (2008) reported a Cronbach’s alpha coefficient of 0.80 for this questionnaire form. In this study, the Cronbach alpha coefficient was 0.91, which indicates a high degree of reliability.
Procedures Before collecting the data, the researchers obtained permission in writing from the institution’s management. All nurses (N = 445) in the hospital were included in the study. However, the researchers could contact only 350 nurses as some were on annual leave (n = 70) or on sick leave (n = 25) during the time when the study was being conducted. The data were collected between May and June 2010. The third author of the study was a director of nursing services in the hospital where the study was conducted. Therefore, the data were collected by the other researchers who handed out the forms in the hospital. Before handing out the forms, the researchers explained the purpose of the study once again and emphasised that the participation was voluntary. The nurses were also asked not to write their names on the forms. It was assumed that the nurses consented to participate if they returned the questionnaire forms. The participants returned 332 forms in total but the researchers had to exclude six of these forms because they were not fully completed and included the remaining 326 forms in the analysis. The response rate was 73.25%.
Data analysis Frequency and percentage distribution and mean analysis were used to describe the demographic variables and motivational factors for the motivation of nurses. Oneway analysis of variance (ANOVA) and Tukey test were used to determine the differences between motivation factors in terms of age, professional experience, institutional experience and work shift. Differences with regard to professional position were analysed with a t-test. Statistical Package for the Social Sciences for Windows 13.0 (SPSS Inc., Chicago, IL, USA) was used in all statistical analyses. In statistical significance testing, P < 0.05 was accepted as statistically significant.
Results In the examination of the respondents’ characteristics (Table 1), all respondents were female and 68.1% of them were baccalaureate graduates. It was also noted 3
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Table 1 The respondents’ characteristics (n = 326) Characteristic Age (years) < 25 25–34 > 35 Educational status Vocational school Associate degree Baccalaureate degree Graduate degree Marital status Married Single Having children No Yes Position Nurse Nurse manager Unit Intensive care Clinic Outpatient Other Professional experience (years) 20 Institutional experience (years) 20 Missing Work shift Day Night Day and night
n
Table 2 Mean scores of motivation factors of nurses (n = 326) %
54 208 64
16.6 63.8 19.6
14 84 222 6
4.3 25.8 68.1 1.8
193 134
59.0 41.0
175 151
53.6 46.4
297 30
90.8 9.2
81 160 36 50
24.8 48.9 11.0 15.3
122 76 78 20 30
37.4 23.3 23.9 6.2 9.2
168 72 47 14 14 11
51.5 22.1 14.4 4.3 4.3 3.4
87 27 212
26.7 8.3 65.0
that 59.0% of the participants were married and 53.6% of the nurses had no children. The majority (90.8%) of the participants were staff nurses and 65.0% of nurses worked in day and night work shifts. The descriptive statistic (i.e. mean, SD) and percentage distributions of the nurses’ perceptions about motivation factors are illustrated in Table 2. An analysis of the mean scores of motivation factors concluded that nurses perceived all motivation factors as influential on their work motivation. However, appreciation (mean = 4.76, SD = 0.500), rewards (mean = 4.69, SD = 0.532) and pension security (mean = 4.68, SD = 0.601) had the highest scores, respectively. The distribution of motivation factors according to age groups are presented in Table 3. The respondents’ perceptions in different age groups regarding status (P = 0.003), authority (P = 0.007), demand for advice 4
Motivation factor
Mean
SD
Effective, %
Partially effective, %
Ineffective, %
Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
4.61 4.69 4.63
0.617 0.532 0.624
96.6 98.8 95.7
2.5 0.6 2.5
0.9 0.6 1.8
4.22 4.76 4.54 4.60 4.68 4.43
0.901 0.500 0.677 0.638 0.601 0.788
80.9 98.5 94.5 95.8 97.3 91.5
13.5 0.6 3.1 2.8 1.5 5.8
5.5 0.9 2.4 1.5 1.2 2.7
4.51 4.57
0.636 0.641
96.4 96.3
2.1 1.8
1.5 1.8
4.33 4.59
0.850 0.653
87.4 95.1
8.3 2.8
4.5 2.1
4.52 4.57
0.650 0.745
93.5 93.6
5.8 3.4
0.9 3.0
(P = 0.014), opportunities of promotion (P = 0.009) and physical environment (P = 0.000) were significantly different. Those respondents who were 24 years old or younger and respondents who were 25–34 years old reported higher scores than the other age groups. The scores of motivation factors were also studied with regard to duration of professional experience (Table 4). Depending on the respondents’ duration of professional experience, statistically significant differences were found on perceptions regarding rewards (P = 0.039), status (P = 0.000), authority (P = 0.000), pension security (P = 0.028), independent working (P < 0.007), mentoring for others (P = 0.000), opportunities of promotion (P = 0.000) and physical environment (P = 0.000). Nurses with a professional experience of 5 years or less and 5–10 years reported consistently higher scores than the other groups, except the motivational factor on pension security. The respondents with a professional experience of 10–14 years reported the lowest scores for pension security (mean = 4.53, SD = 0.681). Depending on the respondents’ institutional experience, statistically significant differences were found regarding perceptions of status (P = 0.002) and physical environment (P = 0.005) as motivational factors. Those respondents whose professional experience was 5 years or less reported much higher scores than the other respondents (status: mean = 4.67, SD = 0.596; physical environment: mean = 4.70, SD = 0.653) (Table 5). ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
Table 3 Scores of motivation factors and respondents’ age (n = 326) Age (years) Motivation factor Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
< 25 (n = 54) Mean (SD) 4.59 4.76 4.57 4.26 4.80 4.69 4.74 4.65 4.54 4.69 4.69 4.44 4.78 4.57 4.63
25–34 (n = 208) Mean (SD)
(0.790) (0.642) (0.815) (0.894) (0.528) (0.577) (0.589) (0.649) (0.862) (0.507) (0.696) (0.984) (0.634) (0.662) (0.784)
4.64 4.69 4.69 4.22 4.77 4.57 4.63 4.69 4.43 4.51 4.61 4.36 4.62 4.51 4.57
> 35 (n = 64) Mean (SD)
(0.573) (0.484) (0.559) (0.919) (0.474) (0.641) (0.568) (0.567) (0.753) (0.606) (0.554) (0.817) (0.610) (0.682) (0.733)
4.50 4.61 4.58 4.16 4.69 4.30 4.39 4.63 4.31 4.34 4.36 4.16 4.33 4.55 4.48
(0.591) (0.581) (0.638) (0.859) (0.560) (0.810) (0.828) (0.525) (0.833) (0.781) (0.804) (0.821) (0.736) (0.532) (0.756)
F
P
1.320 1.182 1.232 0.201 0.881 5.799 5.080 0.228 1.202 4.305 4.797 1.945 7.950 0.223 0.580
0.269 0.308 0.293 0.818 0.415 0.003* 0.007* 0.796 0.302 0.014* 0.009* 0.145 0.000* 0.800 0.561
*P 15 (n = 50) Mean (SD) 4.50 4.60 4.58 4.18 4.70 4.26 4.42 4.64 4.34 4.32 4.32 4.14 4.30 4.58 4.48
(0.614) (0.606) (0.642) (0.850) (0.580) (0.853) (0.859) (0.693) (0.848) (0.844) (0.844) (0.808) (0.763) (0.538) (0.814)
F
P
0.767 2.817 1.852 0.993 1.735 7.455 7.478 3.065 4.082 7.700 6.708 1.895 6.241 1.000 0.572
0.513 0.039* 0.138 0.396 0.160 0.000* 0.000* 0.028* 0.007* 0.000* 0.000* 0.130 0.000* 0.393 0.634
*P < 0.05.
The perceptions regarding the motivational factors were also analysed between the professional position groups. No statistically significant differences were found (P < 0.05).
Discussion Work motivation is essential for enhancing the professional roles of nurses, strengthening the professional image, improving the health care system and increasing the quality of care and health of the individual and community (Oshvandi et al. 2008). It is crucial to grasp the influence of motivation factors in order to ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
develop effective motivation strategies (Kocßel 2003, Filiz 2004, Robbins 2004). This study specifically focused on the perceptions of nurses regarding the motivational factors in their work. The findings demonstrated that the motivational factors were different and varied in terms of the respondents’ age group, professional position, duration of professional and institutional experience. The findings of the study acknowledge that nurses perceive appreciation as the most effective factor in work motivation and the influence of motivation factors varies with age, duration of professional experience and duration of institutional experience. 5
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Table 5 Scores of motivation factors and respondents’ institutional experience (n = 315) Institutional experience (years) Motivation factor Income Rewards Participation in profits Social relief Appreciation Having a status Having authority Pension security Independent working Mentoring others Opportunities for promotion Job attraction Physical environment Teamwork A fair and consistent system of discipline
< 5 (n = 168) Mean (SD) 4.67 4.75 4.72 4.32 4.80 4.67 4.68 4.70 4.49 4.60 4.64 4.40 4.70 4.54 4.57
(0.652) (0.522) (0.608) (0.887) (0.496) (0.596) (0.560) (0.575) (0.797) (0.549) (0.604) (0.884) (0.653) (0.708) (0.808)
5–9 (n = 72) Mean (SD) 4.56 4.61 4.60 4.10 4.79 4.47 4.51 4.69 4.39 4.43 4.57 4.29 4.56 4.54 4.61
(0.554) (0.571) (0.685) (0.906) (0.502) (0.731) (0.769) (0.642) (0.881) (0.784) (0.709) (0.830) (0.579) (0.555) (0.545)
10–14 (n = 47) Mean (SD) 4.62 4.66 4.53 4.15 4.64 4.43 4.55 4.57 4.30 4.40 4.49 4.26 4.43 4.40 4.60
(0.491) (0.479) (0.620) (0.859) (0.529) (0.715) (0.653) (0.715) (0.689) (0.648) (0.655) (0.793) (0.683) (0.681) (0.648)
>15 (n = 28) Mean (SD) 4.36 4.64 4.50 3.96 4.68 4.21 4.54 4.64 4.43 4.39 4.39 4.11 4.32 4.64 4.32
(0.678) (0.488) (0.577) (0.999) (0.476) (0.686) (0.508) (0.488) (0.504) (0.497) (0.497) (0.875) (0.723) (0.488) (0.983)
F
P
2.375 1.393 2.052 2.037 1.583 5.127 1.632 0.596 0.824 2.382 1.617 1.221 4.365 0.880 1.099
0.070 0.245 0.107 0.109 0.193 0.002* 0.182 0.618 0.481 0.070 0.185 0.302 0.005* 0.451 0.350
*P < 0.05.
Appreciation for employees is an important tool for recognition. Appreciated employees feel their work is being noticed, their efforts are valued by others and they feel that they themselves are important (Ellis & Hartley 2005, Abualrub & Al-Zaru 2008, ). Concurring with the findings of our study, previous studies on efficient motivation factors for nurses revealed that appreciation is the leading motivation factor for nurses, (Joshua-Amadi 2002, Karakaya & Ay 2007). A similar kind of study was conducted with health care professionals in Mali and the findings demonstrated that the main motivation factors of health workers were related to responsibility, training, recognition and salary (Dieleman et al. 2003). However, many studies on work motivation have indicated that appreciation by superiors and leaders is highly motivating for workers (Dye 2000, Dieleman et al. 2003, Polyzos et al. 2006, Willis-Shattuck et al. 2008). In Turkey, most of the first-level managers in hospitals are physicians; nurses are represented as secondor third-level managers. Hospitals often have a power culture and autocratic management style. Thus, physicians and other managers are dominant over nurses. Further, nurses are generally seen as physicians’ subordinates and they may be considered as unqualified professionals. The authority and expertise of nurses for clinical decision-making is not recognised (Kaya 2007, Can 2008, Golbasi et al. 2008). Therefore, the fact that nurses perceived appreciation as the most influential factor on their work motivation may be considered as a consequence of the need for attention from others. The study results emphasised that there were differences in the nurses’ perception of motivation factors 6
related to age, professional experience and institutional experience. Status, authority, mentoring others, opportunities for promotion and physical environment were found to be efficient motivators for those aged 24 years or less and 25- to 34-year-old nurses, while rewards, status, authority, independent working, mentoring others and opportunities for promotion were more promising motivation factors for those with professional experience of 5 years or less and 5–10 years. In addition, status and physical environment were occasionally reported as major sources of motivation for nurses with a professional experience of 5 years or less. In other words, certain motivation factors proved to be more influential for younger and comparatively less experienced nurses. These findings were found consistent with those of previous studies. Soykenar (2008) conducted a study in Turkey with health care providers in a university hospital and confirmed that the personnel in the younger age ranges (18–24 years and 25–34 years) and with a professional experience of 5 years or less considered some motivation factors as more effective. A study in USA, Smerek and Peterson (2007) reported that there was a negative correlation between some motivation factors and duration of professional experience and age. Another study in Australia found that the younger group (30 years old and younger) perceived intrinsic motivation factors as comparatively more significant (McCabe et al. 2005). The results suggest that younger and relatively less experienced nurses with an institutional experience of 5 years or less perceived certain motivation factors such as status, authority, mentoring others, opportunities for promotion and physical environment as more ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Motivation factors for nurses
influential, which can be explained by their short career in professional life. The study results also confirmed that nurse managers should take age, professional experience and institutional experience into account in designing motivation strategies, which will assist them in attaining greater success in enhancing motivation. Thus, it will enable the management to efficiently utilise limited institutional resources (e.g. time, human resources and money) and to enhance the motivation of their staff.
Methodological issues and study limitations Certain limitations should be considered in the evaluation of the study results. The study investigated the perceptions of nurses in only one university hospital. That choice was intentional because the nursing services director of the hospital was among the authors and she had been planning initiatives that might promote the motivation of the nurses in her hospital. This particular study, therefore, was partly designed to provide data and a baseline measurement for those initiatives. Consequently, it is not possible to generalise the study results to nurses and/or health care providers in other hospitals in Turkey. The nurses’ perceptions of motivational factors are also limited to the factors that were measured by using the motivation factors questionnaire form.
2009). Therefore, nursing managers need to recognise each worker as a unique individual motivated by different needs. Nursing managers are expected to take certain characteristics of their employees into serious consideration, such as age, duration of professional experience and institutional experience while designing their motivation strategies and they should plan follow-up and modifications in these characteristics. In addition, as motivation factors are susceptible to change (Kocßel 2003), it may be practical to study perceptions of nurses at certain intervals. It is recommended that this study be conducted with a larger sample in future to enable the researchers to generalise the results. It is also considered useful to conduct a comparative study with nurses from different institutions (e.g. public hospitals, university hospitals and private hospitals) in order to gather additional data about the nurses’ choice of motivation factors. In addition, it would be most beneficial to carry out experimental studies to analyse leading factors and investigate the techniques of appreciation that influence the motivation of nurses.
Acknowledgement This study was supported by Akdeniz University Scientific Research Projects Unit.
Conclusion This particular study dealt with motivation factors for nurses. The results showed that appreciation was the leading factor. In addition, motivation factors for nurses varied according to age, duration of professional experience and duration of institutional experience. It was further noted that those with different perceptions towards motivation factors were younger and relatively less experienced nurses with an institutional experience of 5 years or less. Moreover, status, authority, opportunities for promotion and physical environment were commonly perceived differently.
Implications for nursing management Work motivation is an extremely relevant factor that influences the quality and content of work-related outcomes in health care (Toode et al. 2011). Motivation comes from within the person and managers cannot directly motivate subordinates. However, managers can maximise the potential of their employees with appropriate motivation strategies. All employees have some needs to motivate them (Marquis & Huston ª 2013 John Wiley & Sons Ltd Journal of Nursing Management
Source of funding Funding was not provided for this research project.
Ethical approval Ethical approval was not required for this paper.
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