Best Management Practices in Nursing
Nurse’s attitudes relating to ‘job satisfaction’ and ‘organizational commitment’ are of major interest in health care management practices.Statistics show that the total number of nurses working in the healthcare field in the United States has decreased from 2,669,603 in the year 2000 to 2,262,020 in year 2001(World Health Organization., 2006) with a simultaneous decrease in the number of applicants to baccalaureate programs. An American Hospital Association survey has revealed a shocking 1, 26,000 unfilled nursing positions in 715 hospitals in US (Trossman, 2002). A steep in drop in nursing student applicants, factors like subordination of nurses to the medical profession, frequent schedule changes, overloads, burnout, shift work, lack of appreciation by superiors and colleagues, lower wages, short staffing and poor working conditions have contributed towards a reduction of nursing professionals in USA revealing a poorly motivated nurse workforce.
Motivation can be defined as a process which begins with physiological or psychological need or deficiency which triggers behaviour or a drive that is aimed at a goal or an incentive. (Fred luthans, 2005). Motivation is a phenomenon by which ‘motives’ based on ‘needs’ will condition individual’s behaviour. Nurse motivation refers to the way in which wages, drives, desires, aspiration, strivings, or needs, controls or explains nurse behaviour. Motivation is the core of management (Likert 1961). Motive is an inner state that energizes, activates, or moves and that directs behavior towards goals (Berelson 1964). Therefore, if there is no conflict between group goals and personal goals of a member in a group, i.e. Goals of a nurse and a health care organization (in which he/she works) are complementary and not contradictory, then the nurse is motivated to work for the goals of the organization, because, by doing so, he/she will be achieving his/her own personal goals. Research proves that a motivated and productive employee experiences meaningfulness of the work done, experiences responsibility for the outcome of the work done and has high levels of knowledge of the results of the work performed (Hackman, 1976). Loke (2001) gives a comprehensive definition of job satisfaction as “cognitive, affective and evaluative reactions or attitudes”. He also explains job satisfaction as a pleasurable or positive emotional state resulting from the appraisal of one’s own job or job experience. Although ‘job satisfaction’ has received the most attention of all work-related research, ‘organizational commitment’ has recently become increasingly recognized in terms of organizational success. Thus, job satisfaction is concerned with employee’s attitude towards his job and ‘organizational commitment’ is at the level of organization. ‘Organizational commitment’ is an attitude of an individual with a strong desire to remain a member of a particular organization with willingness to exert high levels of effort on behalf of the organization, accepting the values and goals of the organization. Hence, success of a health care organization depends on the establishment of a workplace that will ignite nurse’s commitment or in other words, nurse’s motivation. Thus, motivation is the key factor for organizational success. Managerial planning in a health care facility involves a deep understanding of the motivational drives of the nurses and understanding motivational drives in turn involves a deep study of the factors influencing these drives. It is important for the management to understand the “definite causes” based on operational needs in an analytical fashion.
Factors that Influence Nurse Motivation
Herzberg (1959) recognizes two separate sets of factors that influence motivation of the workers in an organization namely the Hygiene factors and Motivational factors. Hygiene factors are those factors whose presence need not motivate but whose absence will demotivate. He also calls them maintenance factors or dissatisfiers. Hygiene factors include Organizational policy and administration, Technical supervision, Pay, Relationship with the superiors, Relationship with the subordinates, Relationship with the peers, Job security, Personal life, Status and Working conditions. Motivational factors are also known as satisfiers which motivate. They are Work itself, Achievement, Recognition, Advancement, Growth and Responsibility.
Vroom (Fred Luthans, 2005),views motivation as a product of three factors namely, Valence, which denotes how much one wants a reward, Expectancy, which is nothing but an employee’s estimate of the probability that effort will result in successful performance and Instrumentality, which defines an employee’s estimate that performance will result in receiving the reward. Thus, nurses should be regarded as ‘individuals who can think’ and value human dignity. It is important for health care organizations to motivate their nurses by recognizing the rewards, the nurses value the most and not on the rewards the managements offer. Motivation is thus, a result on account of the assured benefits of efforts based performance and performance based rewards. i.e. the nurse awareness of the assured benefits. According to William James (Fred Luthans, 2005), employees form evaluations about themselves with reference to self-esteem and these evaluations of employees have serious implications in organizations. At an organizational level, self-esteem is task based. i.e., it reflects an employee’s self perceived (cognitive) level of ability to perform specific tasks. Thus, self esteem at organizational level breeds a population of motivated individuals with organizational commitment. Nurses who have managers who can communicate to them their trustworthy status and value in the organization will have high levels of self-esteem. This has to be demonstrated practically by means of ‘performance’ based rewards like promotions or cash incentives and by giving genuine respect for employee capabilities. In such a population of nurses who have high task based self esteem, job enrichment techniques have been shown to workout successfully. In job enrichment techniques, the nurses’ intellectual and creative capabilities are challenged. This gives scope for the nurses to learn new skills and results in better performance.
Attribution (Fred Luthans, 2005) is another factor by which nurses interpret and assign causes for their own and other’s behaviour in an organization. There are two types of attributions, namely; Dispositional attribution, that describe a nurse’s behaviour to internal factors such as personality traits, motivation or ability and Situational attributions , that describe a nurse’s behaviour to external factors such as equipments, work environment or social influence. Successful management is all about breeding a population of nurses who attribute their behavior to internal rather than external factors.
The aim of any health organization should be to maximize nurse performance. “Job design studies” is a new field which focuses on various job characteristics that motivate employees. The organizational climate in a health care facility has to be Supportive, offering the nurses a sense of personal importance and responsibility. Management strategies should support positive attitudes toward work by reinforcing motivational factors by giving authority, accountability, a degree of difficulty and specialization to a nurse’s work. This also improves motivational factors such as responsibility, achievement, growth and learning, advancement and recognition. Reduction in performance has been shown to be the greatest when role clarity is low and job security is high. (Yitzhak Fried et.al, 2003). Nurse’s professional performance can be thus defined as a product of motivation and abilities of the nurse, where, any reduction in motivation results in diminished end product, i.e. performance. Hence, every health care organization should strive to encourage nurses to continuously develop new skills, retain them by offering challenging assignments and rewards.
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- Fred Luthans (2005).Organizational Behaviour, 10th edition, McGraw Hill International Edition.
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- Loke, J.C.F. (2001). "Leadership Behaviours: Effects on Job Satisfaction, Productivity and Organizational Commitment." Journal of Nursing Management 9(4): 191-204.
- Trossman, S. (2002). The global reach of the nursing shortage: Electronic Version. American Journal of Nursing, 102(3), 85 – 87. Retrieved October 11, 2006, from Ovid database.
- World Health Organization. (2006). The world health report 2006 - working together for health. (Electronic Version). Retrieved October 10, 2006 from http://www.who.int/whr/2006/annex/06_annex4_en.pdf.
- Yitzhak Fried ,Linda Haynes Slowik ,Zipi Shperling ,Cheryl Franz ,Haim A. Ben-David ,Naftali Avital and Uri Yeverechyahu( 2003).The Moderating Effect of Job Security on the Relation between Role Clarity and Job Performance: A Longitudinal Field Study”, Human Relations, 56(7);787-805.
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