Herzberg’s Two Factor Theory: A Study on Nurses’s Motivation

Introduction

Motivation is what causes every employee to act in a manner satisfying to oneself. It is a process that initiates, guides, and helps to focus on the purpose that one is committed to and encourages a person to give their best at the workplace. Motivated employees will have increased productivity and they voluntarily contribute to the organization’s output. They minimize wastage, maximize their performance and willingly put efforts to increase efficiency. Employees are the most valuable assets of any organization, especially service organizations such as hospitals. Every management should have the interest to know the motivating factors working on their employees.

Frederick Herzberg was a behavioral scientist who proposed the two-factor theory (1959) of job satisfaction which was grounded on two factors namely: motivation factors and hygiene factors, as they could influence one’s job satisfaction at workplace. “Motivation” factors such as equal levels of authority and responsibility, providing appropriate recognition and career advancement, achievement, personal growth and interest in the job may prompt motivation. On the other hand, “hygiene” factors such as organizational policy, interpersonal relationships, job security, physical working conditions, salary and quality of supervision can lead to job dissatisfaction, if not provided.

Several studies are conducted among healthcare professionals to evaluate the most important factors that motivate them to do better in their profession. The study on job satisfaction among nurses in Swedish mental healthcare facilities by Homberg et. al (2018) has found Herzberg’s theory to be useful in exploring job satisfaction of nurses. Nurses are the most significant personnel in hospitals which are primarily meant for nursing care and expert watching. Nurses turnover is a major challenge in Indian hospitals. With the introduction of modern technology and the changing disease management, there is increasing demand on nurses to be highly focused and committed to their profession.

A study was done by Bohm (2012) for the identification and assessment of Herzberg’s motivation and hygiene factors associated with patient satisfaction with the quality of healthcare delivery. He suggests that “among individuals who had not established an opinion related to health care quality, events endorsing a perception of low-quality care are more influential than events underlining high-quality care”. But the perception of high-quality care was not playing the role of motivation or hygiene factor for any group.

Ganesan and Rau (2014) assessed the job satisfaction of nurses in private hospitals in Chennai, India. Their study found that there is a “highly significant impact of the professional variables on job satisfaction of nurses in private hospitals”. Positive motivating measures and professional environment were observed to be crucial in enhancing the satisfaction of nurses which in turn resulted in good hospital reputation due to customer satisfaction through quality services.

Job Satisfaction of nurses who work in private psychiatriy hospitals was evaluated by Aronson (2005). The study planned to describe in detail the job satisfaction of registered nurses (RN) who work in private psychiatry hospitals. In this study RNs reported fair levels of satisfaction, high levels of pride in their hospitals, but low levels of satisfaction with the parent company. Low levels of satisfaction with the parent company may be because of insufficiency of nursing workforce and low financial remunerations.

A study on job satisfaction of Saudi nurses working in Makkah region public hospitals by Alshmemri et al (2016) found that Saudi nurses who had 4 to 10 years of work experience were less satisfied compared to nurses working in other Saudi public hospitals. The motivation factors, hygiene factors and job satisfaction were affected by the demographic factors. As a nurse, to experience job satisfaction and have intention to continue in the same profession is influenced by the recognition of their performance, they experience, adequate vacation and moderate working hours.

Lephalala (2006) studied the factors influencing 136 nurses and their turnover in selected private hospitals in England, using Herzberg’s theory. The quantitative descriptive study found that motivation factors such as advancement, the work itself, responsibility and recognition resulted in increased job satisfaction. As against those intrinsic factors, extrinsic hygiene factors, mostly salary and administration policies, are the most important factors prompting nurses to leave their workplaces.

We considered several studies done based on Herzberg’s two factor theory that provides enough evidence to uphold the Herzberg’s theory even today among university teachers in the developed country, US (Simmons 2020) and in the developing country, Nigeria (Olofinkua 2020). Although empirical testing has declined since the 1970s, there are occasional changes in the scholarly literature. There are more practical applications available and mild references to contrary findings. One such major critic of his theory is by Paul F Wernimont (1972), who raised the point that extrinsic factors which Herzberg considered are external situations whereas the intrinsic factors are mere feelings. Wernimont considered extrinsic factors as variables and intrinsic factors as mere subjective feelings which are quite incomparable with the former.

How would one explain in the light of the two-factor theory the motivation behind the effort taken for "overtime job by the employees in any organization? Kovach (1987) posed this challenge to Herzberg. A study on thousand employees by Kovach found that what managers perceive as motivational forces acting on employees are different from what the employees consider as working on themselves. Money is one among the ‘deficit needs’ which triggers the motivation to put extra effort and time to earn more. The orthogonality of the motivation and hygiene factors thus stand questioned.

In Pakistan, the theory was found challenged with evidence generated from a study on university teachers. In Pakistan, it was disproved by Islam and Ali (2013), a study among university teachers where hygiene factors did not have much influence on motivation, while the motivation factors played a key role in job satisfaction and motivation. Ghasi et al (2013) from the same country studied another set of 300 teachers from four sampled universities and found that hygiene factors work as motivational forces than the motivation factors perceived by Herzberg. A Sri Lankan study (Kumarasinghe and Samaranayake 2020) on public health inspectors found that even when hygiene factors were not satisfying, the motivation factors were not dwindling among public health inspectors.

Researchers would certainly find it interesting to explore the validity of the theory of Herzberg in the presentday context of new generation employees who work in technology enabled organizations and modern amenities at workplace. We explored motivation in nurses, to evaluate if motivation factors are still valid reasons for job satisfaction and motivation among nurses who form the lion share of employees in hospitals. Charitable hospitals offer fairly good but limited working conditions and other hygiene elements, unlike the corporate hospitals which assure luxurious facilities at workplace. This study chose to validate the theory of Herzberg after several decades of his findings in a charitable hospital, particularly among nurses who are deemed to be the embodiment of compassion.

Materials and Methods

This descriptive study was conducted at a tertiary care hospital, Bangalore, in a sample of 200 nurses selected by stratified random sampling technique. Staff nurses who have a certified Post course Bachelor degree in Nursing (Pc BSc), Bachelor degree in Nursing (BSc), and General nursing and midwifery (GNM) and with more than six months of experience in the selected hospital were recruited. Nurses who have submitted resignation, who are on long leave and those having higher qualification or not involved full time in clinical practice were excluded from this study. From each stratum, the samples were selected proportionate to the population. The estimated sample size was 202. A structured questionnaire was used to collect primary data from the nurses. In addition to demographic details, the questionnaire had 28 statements which were statements for assessing satisfaction about hygiene and motivation factors at their workplace. The tool was validated by a pilot study done on a sample of nurses who were not part of the actual sample.

Results

The study sample was skewed towards the lower age group as the characteristic of working population by nature is young. The modal category of the sample was BSc nurses. By years of experience, the sample had highest number in 2 to 4 years category (Table 1). The questionnaire had twelve domains classified into motivation factors and hygiene factors. There were 28 statements in total. Five point Likert’s rating scale was used and each participant was asked to rate each statement as per their experience and understanding. The mean score and standard deviation of each of these variables are presented in Table 2.

Mean of the total score for hygiene was 44.16, median was 45 and standard deviation was 6.82. The mean total score for motivation was 64.63, median was 65.50 and standard deviation was 8.80 (Table 3).

The total score obtained for hygiene factors correlated with the score for motivational factors. The results are shown below in Table 4.

The results showed that there is moderate positive correlation (R=0.688) and it is significant at 0.01 level. This means as the hygiene factors increase the motivation of employees also increase. But there was no significant correlation between age and hygiene factors (R=- 0.031) and there was no significant correlation between age and motivation factor (R=0.059).

Discussion

The theory of Herzberg has been of interest for researchers and practitioners in various disciplines of social and management sciences. Although there was wide acceptance of this theory in the era immediately after its disclosure, there were many studies refuting the same. Alshmemri et al (2016) in their study on nurses in Makkah found that the demographic variables, most prominently age, played a pivotal role in the motivation of nurses. But in the present study in Bangalore, we did not find the demographic variables to have an effect or association with motivation. Laphalala (2006) concluded that British nurses would quit their job if hygiene factors were not satisfactory. This could be a choice in a developed economy where there are several career options. In a developing economy with limited options this could not be true, similar to the observation in the Sri Lankan context by Kumarasinghe and Samaranayake (2020) where public health inspectors continued to work with high level of motivation even when the hygiene factors were not satisfying. Although this study is in a context similar to them, deprivation of hygiene factors was to a lesser extent in the present study. But it is observed that as hygiene factors improved motivation was higher; and a positive correlation was reported.

The present study, was conducted in a cross section of nurses, showing that studies countering the theory of Herzberg are not relevant in this setting and therefore generalization of the results is questioned. Nurses being a unique workforce driven by compassion and concern for people are also a workforce expecting hygiene factors as well as motivational factors at their workplace to attain job satisfaction.

Conclusion

This study in a large healthcare facility underlines the theory of Herzberg that there is strong relationship between hygiene factors and motivation factors. It implies that increased level of satisfaction due to hygiene factors is a prerequisite for increasing motivation among employees. Our attempt was to verify if hygiene factors are important among nurses, a workforce that demonstrates empathy and compassion at their workplace. In charitable settings of healthcare, we observe selfless service of nurses, who are in the frontline and offer comfort and care to the sick. Our study stands as proof that even in such situations, there is strong positive correlation between hygiene factors and motivation factors.

Limitations

The study was limited to the setting of a not-for-profit healthcare facility. But we have not considered the spiritual and philanthropic aspects of the career choice of these nurses.

Conflict of interest

The study was self-funded and there is no conflict of interest.