Motivation is defined as “the factors that initiate or direct behavior” (Sullivan, 2018). Highly motivated, satisfied, and knowledgeable staff nurses create a symbiotic relationship with the healthcare organization’s goals, which will positively impact patient outcomes and satisfac-tion as well as staff retention.
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Identifying and utilizing these factors to produce positive patient outcomes is vital in the healthcare field but can prove challenging to those in leadership roles. Staff motivation is a multifaceted issue that is made more difficult by the ever-changing nature of the healthcare setting.
The purpose of this paper is to explore methods of maintaining highly motivated nursing staff and review the literature related to staff motivation in nursing. Further-more, this paper will apply information from current literature to a 12-bed pediatric intensive care unit case study in order identify methods to increase and maintain high staff motivation.
Explanation of the Nursing Issue
For the purposes of this paper staff motivation, as it relates to nursing, is defined as both intrinsic and extrinsic factors that influence nurses’ behavior (Dill et al., 2016). Staff motivation or nursing motivation may be used interchangeably in this paper. Motivation factors may be ei-ther intrinsic or extrinsic.
Intrinsic motivation is motivation that comes from within a person This type of motivation can be thought of as the positive feeling in the process (Wooley & Fishbach, 2018). Extrinsic motivation originates from outside of a person, such as gaining knowledge, money, or reward (Wooley & Fishbach, 2018).
Staff registered nurse (RN) is defined as any nurse providing direct patient care in a healthcare organization. Staff RN’s may participate in committees or shared governance but have no managerial roles within their work environment. Nursing leadership is defined as nurses within an organization that have the ability to influence the nursing practices of their co-workers, although this person may not have any defined power within the organization.
Nursing management is an assigned role within the organization. Some literature uses the term nurse directors to describe management within the nursing field. This person or persons have the ability to enact change through policy and regulation. Quantitative data on nursing motivation is typically obtained from surveys of working nurses either by a hos-pital or researcher.
According to Henderson, Schoonbeek, & Auditore (2013), some factors impacting staff motivation include the organization of nursing work, demands to focus on service requirements, and an emphasis on completing tasks. The modern-day organization of nursing work focuses on task completion which leaves little time dedicated to understanding patients on a personal level (Henderson, et al., 2013).
Because of the rise in accountable care organizations (ACOs), reim-bursement is becoming more closely linked with quality of patient care (Sullivan, 2018). This reimbursement model is causing an increase in focus on service requirements and nurse-sensitive indicators. This, in turn, creates more focus on task completion.
These factors do not take into account a staff RN’s motivation for providing excellent patient care, but instead focus on the rea-sons management and the healthcare organization are motivated to provide high-quality care. To understand how to motivate staff the organization’s nurse managers must first understand what motivates nurses.
Nurses are highly motivated by both intrinsic and extrinsic factors; however intrinsic factors are the largest motivation (Toode, Routasalo, Helminen, & Suominen, 2015). Nurse managers should marry a nurse’s desire to help others with the organization’s goal of high-quality patient outcomes. Many issues can negatively impact motivation among nursing staff—nurse-patient ratio and autonomy are examples.
Dill, Erickson, and Diefendorff (2016) published study data that examined nursing moti-vation and its relationship to three employment outcomes-physical well-being, staff retention, and nursing burnout. Regarding the overall importance of nursing motivation Dill et al. (2016) state:
When intrinsic motivation is low, workers do not enjoy their job tasks, but they put pres-sure on themselves to do the tasks in order to help others. Here, prosocial motivation is based in guilt and a sense of obligation, and workers may respond by “burning out” or in-tending to leave their job. (p. 104)
Dill, Erickson, & Diefendorff (2016) identified three types of nursing motivation in their re-search. Prosocial is motivation that is driven by the desire to do good for other people. Intrinsic motivation is motivation that is derived from interest in the work itself. Extrinsic factors of moti-vation are from physical rewards such as money or benefits.
Physical well-being was tracked by self-reported episodes such as dizziness and increased heart rate. Of the three motivating factors none showed higher correlation to negative physical symptoms. Both nurses motivated by intrin-sic and extrinsic factors reported a lower rate of negative physical symptoms; Prosocial motiva-tion showed no significant correlation to reports of negative physical well-being (Dill et al., 2016).
In this study Dill et al (2016) found nurses motivated by intrinsic factors and nurses moti-vated by extrinsic factors were less likely to report intention to leave their current employers, while prosocial motivation showed no significant impact on staff retention. Nursing burnout is physical, mental, or emotional exhaustion brought on by the responsibilities of nursing work.
Prosocial motivation was found to be the highest indicator of nursing burnout, while both intrin-sic and extrinsic factors correlated with a decreased incidence of nursing burnout acceding to nurses’ responses in this study (Dill et al, 2016).
Ahlstedt, Lindvall, Holmstrom, and Athlin (2018) published research that adds a more robust understanding of nurse motivation through a quantitative study. Ahlstedt et al. (2018) di-vide motivating factors into three separate categories—work motivation linked to interpersonal support, work motivation linked to progress, and actions that directly facilitate the work being performed.
Work motivation linked to interpersonal support, also called the nourishment factor, is related to relationships with other healthcare professionals such as nurses, doctors, and nursing assistants. This category is further broken down into three sub-categories. The first is “solidarity and a friendly atmosphere”, which is about activities not related to patient care at all, for example asking about a co-worker\’s vacation or life outside of work.
This occurs when co-workers “see the person behind the professional role” (Ahlstedt et al., 2018). The next sub-category occurs when nurses are confident in asking for and providing support. The last sub-category is “respect and trust knowledge in the daily work” (Ahlstedt et al., 2018). According to Ahlstedt et al. (2018) confidence in the skill set and knowledge of co-workers increases work motivation among registered nurses.
The progress factor, or work motivation linked to progress, occurs when advancement of work tasks occurs even when met with the challenges that occur within the healthcare setting (Ahlstedt et al., 2018). A patient deterioration or numerous patients within the unit de-compensating simultaneously can create challenging situations within a hospital unit, but collaboration and problem-solving proved to have a positive impact on nursing motivation (Ahlstedt et al., 2018).
According to Ahlestedt et al. (2018) “Knowledge grew and moved the learning process forward when registered nurse colleagues discussed together, supported each other and taught new colleagues and students during the daily work.” (p. 36), illustrating the im-portance of learning, education, and knowledge advancement in staff motivation.
The catalyst factor is actions that directly facilitate the work and contribute to maintaining highly motivated nurses. This category encompasses several points—access to appropriate resources (including appropriate staffing levels and ability to take breaks), autonomy, and clear goal-setting from all disciplines (Ahlstedt et al., 2018).
Toode, Routasalo, Helminen, & Suominen utilized the self-determination theory to ana-lyze data related to nursing motivation. This study found that while nurses are motivated by both intrinsic and extrinsic factors nurses were most highly motivated by the enjoyment derived in their specific job (Toode et al., 2015). Nurses that participated in professional training more than 7 days a year were highly motivated by both intrinsic and extrinsic factors, illustrating the im-portance of educational opportunities for staff (Toode et al., 2015).
This study also noted chang-es in motivating factors over the course of a nurse’s career. Head nurses, older nurses, and more experienced nurses were all more extrinsically motivated than other surveyed populations (Toode et al. 2015). Toode et al. (2015) theorize this is related to an increased desire to “prove oneself” as more experience or responsibility is gained over the tenure of a nurse’s career.
Decreased intrinsic motivation is linked to negative outcomes, both for the nurse and the healthcare organization. Poor intrinsic motivation may lead to exhaustion and poor job satisfaction because the demanding day-to-day work of nursing may not be satisfying higher psychological needs of nurses (Toode et al., 2015). In addition, nurses focused on extrinsic factors such as blame may not keep up with the educational requirements needed to provide high quality patient care in the ever-changing field of healthcare (Toode et al., 2015). Toode et al. (2015) concluded:
Most of the nurses were motivated more intrinsically than extrinsically. Therefore, it is important to maintain and solidify their current state of motivation, so they feel continu-ously valued and that their autonomy is respected. In the area of extrinsic work motiva-tion, from a practice perspective, it is important to discuss how to decrease the amount of work overload and how to develop the practice environment to meet both the needs of the service and those who provide it. (p. 255)
Kjellstrom, Gunilla, Areskoug-Josefsson, Gare, and Back (2017) report that ambition to provide quality care is the most cited reason for high motivation among nurses. Positive interper-sonal interactions with patients, co-workers, and management also positively impacted nursing motivation. (Kjellstrom et al. 2017). Kjellstrom et al. (2017) determined that maintaining a highly motivated and satisfied healthcare workforce also requires discretion in professional autonomy and collaborative teamwork, and an improvement culture.
The study implies that beneficial factors are a culture of non-hierarchy and collaborative teamwork, but also an atmosphere of kindness and enjoying each other’s company. We conclude that the investigated well-functioning units have or-ganizational structures and processes, which provide direction, alignment, and commit-ment. (p. 499)