¶ … Driving Forces Behind Motivation For some the notion of staying motivated seems unnatural. This is especially the case for healthcare workers, nurses in particular, who face long shifts and inadequate support due to nursing shortages. Healthcare organizations are facing their own crisis as they struggle to recruit qualified nurses then encourage them to remain motivated despite grim circumstances. Given the current healthcare climate, which is demanding and often overburdening, one challenge organizations must face is discovering new ways to motivate staff. But what is motivation and how does an organization motivate an already overworked staff?

For centuries organizations have worked to develop clear and well defined plans for motivating staff. The first challenge organizations must face is understanding what motivation is. Without understanding first what motivation is, it is impossible to motivate workers. Many believe that you are either born with motivation or without. Other myths suggest that workers who are motivated are more productive than those who are not. Still others suggest that motivation can be mass produced (it can't). Many organizations fall victim to this idea, suggesting that they can motivate the masses within an organization using some simple ploy. Others believe that it takes money to motivate. From a realistic perspective, it takes more than money to motivate people. In fact, there are thousands of people not motivated in the least by money.

What does it take to motivate people? The research suggests that motivation is different for everyone. There are many theories that attempt to define motivation and establish simple strategies for motivating individuals and groups. Each of these provides valuable insight into human motivation, and may help resolve some of the current motivational issues facing healthcare organizations today. These are described in greater detail below.

General Theories of Motivation

Many researchers have attempted to describe motivation in the past. Many agree that motivation carries with it three characteristics. Among these include activities or behaviors that "activate human behavior," activities or directives that direct behavior to achieve a goal, and factors that may sustain this behavior over time (Motivation, 1). Organizations have concerned themselves with uncovering the mysteries of motivational theories in order to establish a competent and content workforce. Many believe that improved motivation will also lend itself to greater productivity and overall success. For the most part, these ideas are valid.

Most theories of motivation define motivation and work to help managers uncover ways to encourage or sustain motivation over long periods of time. Such practices will certainly benefit the healthcare sector, where staff shortages may continue to become problematic if remaining staff do not feel motivated to continue working.

Aside from general theories of motivation, there are several specific theories that help define how individuals are motivated and what steps managers must take to sustain their efforts. These are presented below.

Process Theories of Motivation

Many theories exist that attempt to explain motivation. Process theories for example, emphasize what people think about before they decide to take action or not in a particular situation. J. Stacy Adams is one person that supports the process theory of motivation. His equity theory suggests that people are motivated when they perceive a situation to be unequal (Bolton, 1). Thus, someone will examine how other people doing the same work they are perform and whether they seem motivated or place much effort in the task at hand. People will also according to this idea, put as much effort into a task as they see others to accomplish the same rewards.

Using this example in a healthcare setting, if a nurse sees another nurse not pulling their weight or working extra shifts, yet still receiving the same rewards as any other, that person is less likely to be motivated or understand the point of working harder. This idea follows the logic that people believe they should be rewarded based on the amount of effort they put into something.

The idea is also that people shouldn't be rewarded for performing below a certain standard, and if they are other workers will become less motivated. Adam's equity theory suggests that in any given situation people may feel under, over or equitably rewarded. If they feel under or over rewarded they are more likely to take action to minimize any perceived inequities. Equity theory is more akin to establishing a work environment that is equitable or fair, with the idea that this alone will lead to a highly motivated staff (Bolton, 2005).

Process theories are more involved with examining the dynamic relationship between people or events that influence people and why certain events might change someone perspective....

Process theories unlike content theories, focus more on the cognitive processes that occur within each individual.
Another example of a process theory is expectancy theory. This theory, developed informally by Victor Vroom, suggests that people remain motivated depending on how much they want something and how likely they perceive their chances of fulfilling this needs. The idea is that for an individual to remain motivated, they most expect that they will be able to achieve their needs based on a defined amount of effort or performance (Motivational in Workforces, 1). This theory focuses on people's expectation that a circumstance will end in their favor, thus leading them to engage in high performance activities.

Managers can use this theory very easily in a healthcare environment to motivate nursing staff. The first step to take would be to define what outcomes employees expect from a given situation. Let's say for example a nurse works a defined number of hours overtime with the expectation that they will acquire a certain percentage raise after a year. It is up to the manager to first determine whether this expectation is attainable, and once verified, to encourage and direct the employee to ensure the desired outcomes are met. In most cases expectancy theory requires a large enough reward to motivate employees sufficiently.

Content Theories of Motivation

Content theories are different from process theories in they focus on individual people and their behavior within a given environment. Examples of people supporting the content approach including Maslow and his hierarchy of needs, which suggests that people will seek out an environment that fulfills their basic needs from most important to least important. People are motivated to achieve this. Most content theories support the idea that people will remain motivated as long as they perceive their needs are being satisfied or met.

Like Maslow, the ERG theory supports a content approach to motivation. This theory suggests that people first seek to fulfill physiological and material needs that will sustain their well-being. Once these needs are met people will seek interpersonal relations and opportunities for personal development. If at any time an individual does not feel these needs are met satisfactorily, they are likely to move on or remain de-motivated.

McClelland goes one step further suggesting that to remain motivated organizations need to help employees fulfill needs by setting clear and moderately challenging goals (Motivation and Workforce, 1). The job of a supervisor is to provide feedback to help individuals stay on track to meet their goals. These goals related to achievement. McClelland also suggests that people have a need to affiliate or work and interact with others, as well as a need for power and control.

Goals setting is proven time and time again to help motivate individual staff members to achieve their objectives and remain motivated. Two of the more well-known proponents of goal setting include Locke & Latham (1990) who suggest that motivation may be approached from a conscious perspective (Drillings & O'Neil, 1994). These authors simply suggest that individuals that perform better and remain motivated are simply those that have "well defined performance goals that direct their tasks correctly and meaningfully" (Drillings & O'Neil, 15).

Dozens of studies support a direct relationship between performance and goal level (Drillings & O'Neil, 1994). Atkinson (1966) conducted one such experiment that supports a linear relationship between goal level and performance. Goals have to be "specific and difficult" in order to improve performance and motivate individuals in a work environment (Drillings & O'Neil, 15).

Goals must also be action oriented, meaning they encourage individuals to take action to achieve a higher level of performance and remain satisfied throughout the duration or an assignment or work role.

Causes, Approaches and Dealing With Motivational Issues

Determining the causes, approaching and dealing with motivational issues in the healthcare industry is essential to retain a staff force of competent and caring staff members, especially nurses. The first step organizations must take is evaluating what factors contribute to de-motivation. Many have already been identified, including staff shortages and heavy workloads.

Other important considerations may include perceived lack of recognition or appreciation for the time and effort on the job. Many nurses believe that they contribute more to patients than other members of staff, especially giving the one on one attention they offer patients in a health care setting. It is easy to understand how one may perceive their rewards as inequitable, and subsequently lose motivation for their work.

One approach managers may take is addressing their own motivational myths. It is important…