Motivating nurses: addressing healthcare worker retention through motivation theory

¶ … 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.

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 that managers understand that achieving motivation is impossible with a one size fits all approach. Simply by reviewing the many theories available on motivation, one can understand the importance of tailoring their solutions to individual staff members. In many instances a combination of approaches may often be the best solution for nurses working in overburdened healthcare environments.

Managers should also understand that motivation may not be something that is intrinsic. They can better understand this by working with staff members to develop pointed, directed and challenging goals, then reviewing their staff's progress toward meeting these goals over time. Doing this alone will likely result in some improved understanding of what motivates staff. Those staff members achieving their goals are likely to be the ones most motivated over time.

Assumptions also often come into play regarding motivation. Far too often managers assume that monetary issues play a primary role in employee's motivational status. However, if organizations more frequently surveyed employees directly regarding their needs, they are likely to find that in fact, relatively few individuals if any are motivated strictly by financial incentives. Simply conducting a study like this may reveal enough information for an organization to develop an adequate strategy for combating de-motivation.

Lastly, it is vital that managers acknowledge motivational problems early on. If they wait too long staff members are less likely to take their concern seriously. Most will have already adopted the idea that they are under appreciated if too much time goes on between performance failures and intervention.

Conclusions

As we can see from the research, motivation is defined in many ways. There are several different approaches to human motivation. Some theories suggest that individuals are motivated based on their ability to satisfy their essential needs. Others suggest that motivation is a cognitive process whereby individuals evaluate their circumstance based on the performance and rewards of those around them.

The most important facts managers take away from this is that everyone is motivated differently. It is impossible to develop an explanation for motivational problems and a solution using a single strategy. A better approach, in healthcare or in any industry, is to closely examine the needs of individual employees in order to decide the best approach toward resolving motivational problems and encouraging future motivation.

Based on the research presented above, one solution that seems applicable to the general public is the idea of goal setting. No matter what ones primary reasons for engaging in meaningful work, if someone is able to set challenging and meaningful goals, their chances for success are much higher. Why? Goal setting provides a framework for direction. It encouraged employees to seek out a certain reward, whether intrinsic or otherwise, based on a series of objectives they create for themselves. There are dozens of studies supporting the use of goal setting regardless of what theories of motivation an organization decides to adopt.

In the healthcare setting, goal setting can be used to help motivated nursing staff. If combined with other approaches that ensure all employees are rewarded on a measurable scale, based on their efforts and achievements, staff is much more likely to remain motivated and overcome future motivational difficulties with minor effort.

References:

Atkinson J.W., & Feather N.T. ( 1966). A theory of achievement motivation. New York: Wiley.

Bolton, L. (2005). "Process theories of motivation." Information Technology and Management. Retrieved August 5, 2005: http://opax.swin.edu.au/~388226/howto/it2/mproc.htm

Drillings, M. & O'Neil, H.F. (1994). Motivation: Theory and research. Hillsdale, NJ:

Erlbaum Associates.

Kuhl J. ( 1981). "Motivational and functional helplessness: The moderating effect of state vs. action orientation." Journal of Personality and Social Psychology, 40, 155-170.

"Motivation." Retrieved August 4, 2005:

http://www.acad.polyu.edu.hk/~msklma/OM/motivation.html

'Motivation in Workforces." Retrieved August 5, 2005:

http://www.ee.uwa.edu.au/~ccroft/em333/lecl.html