Exploring Role of Motivation on Job Performance – Nurses’ Perception

Introduction

Today as the work environment is highly competitive and dynamic, employees are integral part of an organization because a large part of the daily operations are tended by them. Therefore, by and large, success of an organization in achieving the strategic objective is dependent heavily on the performance of employees. This implies that human resources need to be handled carefully, since they are a special asset that needs focused managerial attention and time. It is therefore, crucial to first identify the factors influencing performance and take appropriate measures to improve the organization. An employee’s performance is a result of their ability and motivation, where ability includes the training, skills and resources required for performing a task and the inner force that compels individuals to work towards something is described as motivation. Regardless of sector and size of the industry, motivated employees are required in any organization to function effectively. An indispensable asset of the organization is its human resources that guarantee its performance, productivity and prosperity. Motivated employees are satisfied, committed and work with zest. The result of a motivated workforce includes employee loyalty, retention, improved job performance and harmony. These are the factors that add to a large extent to the development of the organization.

The largest workforce in the healthcare industry comprises of nurses. Nurses play a prominent role in care of the patient, assisting to heal, protect, soothe and prevent patients from pain and diseases. Nurses work in complex situations that require utmost professionalism and competency in patient-care behaviour and providing nursing care. The work environment in the hospital being quite challenging, puts a lot of burden on nurses. De Lucia and Palmieri concluded that as there was a shortage of nursing staff, the nursing profession as a whole is overloaded (by number of patients & number of tasks).¹ Nurses work under constant overload, involving in multitasking and facing frequent interruptions. This stressful work environment and current trend towards commercialization in healthcare may reduce the nurses’ motivation level. If these circumstances are left unaddressed, may cause a negative effect on their job performance and affect overall quality of care. More than 40% of nurses working in hospitals in the US reportedly lacked motivation. Nurses were found to be highly demotivated as compared with other categories of workers in the US.²

In order to have a well-functioning health system, an essential prerequisite is a highly-motivated staff. Low motivation among healthcare human resources has often been acknowledged as a key predicament in health service delivery. The major concerns are motivation and retention of healthcare human resources. Lambro mentioned that although employee motivation is a very important constituent of health systems’ performance, it is largely understudied.³ Franco et al., implied that issues related to motivation at work may manifest in many ways, but common signs include: tardiness and absenteeism, lack of courtesy to patients, failure to treat patients in a timely manner and poor process quality such as not properly examining the patient.⁴ Health sector performance, and in turn, health outcomes, is critically dependent on worker motivation.⁵ Healthcare is highly labor-intensive, and thus, efficiency, service quality, and equity are all directly intervened by employee’s willingness to put themselves to their task. Though performance of workers is dependent on, or limited by, availability of resource and competencies of employees, these factors by themselves are not sufficient to guarantee preferred worker performance. Increased motivation combined with effective management practices and supervision creates these conditions for a more effective workforce performance.

One the most compelling challenges facing today’s healthcare organizations is how to make sure that the nurses are highly motivated. In consideration of this issue, it has been found that the most commonly adopted technique among organizations is the incentive program. The purpose of the program is to reinforce positive behavior, reward productive performance, rouse interest in employees and most notably motivate them. There is a need to understand the factors influencing motivation of nurses in order to take necessary actions and build a dedicated nursing workforce.

Workplace motivation strategies are commonly adopted in organizations to improve profitability by increasing motivation and productivity, reducing absenteeism and turnover, and to retain talented and skilled employees. Typical motivation techniques such as incentives, rewards and recognition are often used complementarily to motivate employees. The World Health Report defines incentives as “all the rewards and punishments that health providers face as a consequence of the organizations in which they work and the specific intervention they provide.” Incentives are important tools that organizations can use to attract, retain, motivate, satisfy and improve the performance of staff. They may be positive or negative, monetary or non-monetary, tangible or intangible.

Worker performance is a consequence of three factors as following: the ability of staff to do their job, the motivation of staff to put in effort to do the job, the organizational support to do the job well.^6,7 Performance of workers undoubtedly depends on their level of motivation, and that encourages them to come regularly to work, carry out their tasks meticulously, be flexible and be willing to do the necessary tasks. However, motivation affects only those aspects of performance that can be brought under the worker’s personal control. Hence motivation is not synonymous with performance, nor is performance unequivocally determined by motivation.⁸

Condly et al., in their paper analyzed the role of incentives to motivate employee performance.⁹ A 22% gain in performance was seen as a result of the effect of all incentive programs in all work environments and on all work assignments. It was seen that incentives that were team-directed when compared to individuallydirected incentives, showed a visibly greater effect on performance. Money as an incentive, in comparison to non-monetary and tangible incentives (gifts, travel) was found to contribute to greater performance returns. Long-term programs showed better performance returns than shorter-term programs.

A study conducted in South Africa by Peterson reported that there was a negative effect on the job satisfaction levels of employees by the extrinsic factors such as working conditions, supervision, management styles and salaries.¹⁰ Most of these respondents were discontented with their remuneration, supervisor and staff interaction and with the working conditions at the hospitals. They revealed that organizational climate was not favorable and did not help in stimulating a higher level of motivation.

Certain factors have been reported to play a role in nurses’ level of motivation such as nurses’ workload, autonomy in the workplace, salaries, benefits, bonuses, reward systems, opportunities for growth and development, nursing leadership styles, nurse-physician relationships, recognition and appreciation for good work.¹¹ The work done by Nilsson and Stomberg, as well as by Roseanne Daniel, identified the factors that help to increase nurses’ motivation such as prospects for growth, working conditions and supervision.^{12, 13} Some incentives have been helpful in persuading nurses to return and remain in the workplace such as innovative work schedules.¹⁴

Wieck et al., worked on a nurses incentives project, and identified potential areas for intervention depending on the generational nurse characteristics.¹⁵ The Millennials and Gen Xers both ranked overtime and premium pay among their most important incentives while the Boomers and older nurses stressed pension and retirement benefits. All the generations appear to value premium pay described as “time and a half or double-time pay for working weekends or holidays - not overtime.”

Batista et al., and Tavares had concluded that even though remuneration is a motivational factor at work, it is not the main motivator.^16,17 Other factors have been mentioned by nurses, such as stability attained at work and commitment to the population. Remuneration was indicated as one of the factors of greatest dissatisfaction in nurses’ work. Nurses believed they were poorly paid, contemplating the kind of work that they do, the hour load and responsibility assumed. Tavares indicated other motivational factors such as liking what one does, an acceptable relationship with the multi-professional team, the likelihood of professional growth, the hour load and the working conditions given by the organization. Yet, in another study, Vévoda et al., concluded that nurses considered wages and the care given to the patients as the most important factors at work, based on the findings of their study in the Czech Republic (included 122 hospitals).¹⁸

Motivating the nurses is one of the greatest challenges faced by healthcare administrators in today’s dynamic environment.  Though there is a lot of literature addressing the subject motivation of nurses, there is a need for individual hospitals to identify factors motivating their nurses and take measures to improve job performance. The present study contributes to the research on nurse motivation in two ways –

a)       It adds to existing literature as it enforces the role of extrinsic rewards in motivation.

b)      As there exists a dearth of literature regarding this topic in medical college hospitals especially in South India, this study aimed to fulfill this gap, the results of which could be generalized to other hospitals of this type.

Hence, this paper aimed to examine the role of various motivational factors on the job performance of nurses.

Materials and Methods

The research approach adopted in this study was a descriptive method. The study was conducted in a tertiary care teaching hospital. Data was collected from the primary source: the nurses working in private and general wards of the hospital using a structured questionnaire. A sample of 100 nursing staff was selected by simple random sampling technique. The tool comprised of a questionnaire that was administered to the respondents. The questionnaire comprised of three sections that included - demographic data, assessment of the factors motivating the nurses, assessing the effectiveness of motivational factors on the job performance of nurses. The respondents were asked to rate on a Likert five-point scale. Pilot study was conducted to check the feasibility of the tool and the questionnaire was administered after necessary corrections were made.

Collected data was analyzed using descriptive statistics such as frequency, percentage, mean and standard deviation. Mean (%) was used to assess the importance of motivation factors and was used as basis of classification as follows: above 90% - most important factors, 60%89% - moderately important, below 59% - least important. Regarding effectiveness of motivation factors on job performance, classification was as follows: above 90% - most effective, 60%-89% - moderately effective, below 59% - least effective.

Results

The results of the study included the findings of the survey conducted to assess the factors motivating the nurses, to assess the effectiveness of motivational factors on the job performance of nurses and their demographic details.

From the sample of respondents, it was observed that 80% were females, 56% were less than 25 years of age and 32% were between 25-30 years, 64% were B.Sc nurses and majority (64%) had experience of one year.

2. Assessment of factors motivating the nurses

This part was an attempt to understand what motivates the respondents. It was divided into two parts i.e. monetary factors and non-monetary factors (further grouped as tangible and intangible factors).

According to the respondents, the most motivating factors consist of positive working environment, job security. Moderately important factors include good relationship with the team members, interesting work, opportunities for career advancement and effective internal communication, salary /bonus, incentives and monetary benefit packages, adding more responsibility to the workload, discount in food and accommodation, award /trophies, certificate or letters.

3. Assessment of effectiveness of different motivational factors on the respondents’ job

This section was used to identify the effectiveness of different motivational factors on the respondents’ job. A list comprising of 27 potential incentives that was built upon the previous factors were given to the respondents and they were asked “Is this factor important and makes you to perform better at work?” The factors were ranked in accordance to their effectiveness.

As per the above data collected, the first five motivational factors had the most effect on their job performance. They included job security, pleasant working atmosphere, supportive management, retirement benefits and insurance policies and cash bonus. Rest of the motivational factors had a moderate effect on their job performance which included job location and placement, feedback from superior, being asked for advice and suggestion, promotion and career growth in the company and an award or certificate to recognize achievements, friendly social gestures (smiles, pat on the shoulder, greeting etc), personnel appreciation, being recognized by peers, a celebration or other fun team-building events. Factors such as increased responsibilities within current job, newspaper or magazine subscriptions to improve the general and current knowledge had the least effect.

Discussion

Based on the findings of this study, the most effective strategies to motivate the nurses include focusing on nonmonetary – intangible benefits. Interestingly financial incentives like salary or bonus did not come among the first five motivating factors among the respondents.

Among the factors which they found to be effective in their job performance, the first five included creating a job security, pleasant work environment, support from management, retirement benefits and cash bonus. This implies that nurses perceive that it is the hospital management’s responsibility to provide them with resources, benefits, positive work environment for them to be effective. This enforces the role of extrinsic rewards in motivation.

Hospitals can improve the work environment by preparing nurse leaders to build an environment that are conducive to friendships, promoting respectful relationships between staff and physicians, peers, administrators, and other departments and facilitating good communication. Support from management is seen in appreciating & honoring achievers, opportunity to be on task forces, encouraging staff to higher education. Financial benefits like bonus, retirement benefits were also considered effective. It is important to recognize that only when a benefit is important and available to the nurse, it was considered to be a true incentive. 

Nurses depending on their personal requirements, require different type of incentive program to be motivated. Hospitals can consider various types of strategies to motivate the nurses. They can allow nurses to select from a menu of benefits and structure the benefit program that maximizes their incentives. There is a need to make benefits package transparent and individualized. It is important to focus on ways to offer the benefits that nurses want. Of particular importance is committing resources to recognize those nurses who truly contribute to solutions by innovation or longevity.

Importance of monetary factors cannot be ignored as it could be a maintenance factor. The salary should be competitive and maintained as per the industry standards and should be revised from time to time. Also, it must be noted that adding more responsibility to the current workload may not improve the performance of the individual and may have a negative effect.

Conclusion

In conclusion, this study showed that motivation was influenced by both financial and non-financial incentives. The main motivating factors for the health workers in this hospital were positive working environment and job security. Respondents also mentioned that the motivational factors having most effect on their job performance were job security, pleasant working atmosphere, supportive management, retirement benefits, insurance policies and cash bonus. The knowledge of motivation factors allows the implementation of targeted strategies for nurses to increase their performance. A continued effort to learn about the perception of the nurses regarding what motivates them will help management not only in motivating them, but also in retaining them. It will help in creating a dedicated workforce and will build the image of the hospital.

limitations of the study

As the study was conducted in a tertiary care hospital, the findings were limited to this type of setup. The motivational factors for nurses working in nursing homes or smaller hospitals could be different.