Background to the Study
Nurses constitute the largest human resource element and have a great impact on quality of care and patient outcome in health care institution (Muller, Bezuidenhout & Jostle, 2011). A motivated and qualified workforce is crucial to increase productivity and quality of health services in order to contribute to achieving health services targets. Therefore, motivation in health institutions is absolutely important because it could change the behaviour of employees positively. That is why managers believed that when they establish motivated employees in the workplace, they can observe significant achievements in the organizations (Wade & Tavris 2008). Every organization and business wants to be successful and have desire to get constant progress. The current era is highly competitive and many institutions regardless of size, technology and market focus are facing employee retention challenges (Ahmed & Oranye, 2010). To overcome these challenges a strong and positive relationship and bonding should be created and maintained between employees and their health care institutions. Human resource or employee of any organization is the most central part so they need to be motivated and persuaded toward task fulfilment (Share, 2010).
Professional nurses play a vital role in the provision of health care globally. The performance of health care workers, including professional nurses’ link closely to the productivity and quality of care provision within health care institutions (Letvak, 2008). Nursing care is an integral component of patient care and is an important determinant of quality of health care services. However, nurses work within a climate of uncertainty and disempowerment along with high patient’s demands placing them under considerable stress (Lemieux, 2009). This condition threatens both the physical and emotional well-being of nurses and the profession itself, and may result to low commitment which in turn may contribute to disengagement or withdrawal of nurses from the work place. Consequently, it threatens the hospital functioning and the quality of care since low nurses commitment leads to absenteeism and poor performance (Polit & Beck, 2012).
In Nigeria, findings show that workers and their managers often perceive motivation differently. In addition, little is known about the motivational factors that are important for health workers in the hospitals (Brayfield & Crockett, 2010). According to Murphy (2009) the real problem facing Nigerian health workers is that they are unmotivated and underappreciated. Murphy asserted that the reward system in Nigeria is almost the poorest in the world. A common manifestation of poor performance as a result of poor motivation among nurses can be seen in long hospital waiting hours, lack of courtesy to patients and the general public and poor quality of care (Ezoha, Amasa & Ezeakaluo, 2009).
Motivation according to Igboeli (2010) comes from the Latin word Movere which means to move. It is a general term that encompasses all those inner forces such as desires, drives or motives, wishes which kindle, direct and sustain behaviour towards a goal. Motivation is the process that stimulates people to act and drives them to achieve a goal. People who are motivated are stimulated / triggered to perform a task while people who are not motivated or who are less motivated do not feel such stimulation (Hank, 2008). It is the incentives, inducement and rewards that are given to workers at regular basis so as to boost their moral and enhance high performance. Furthermore, motivation is the catalyst that spurns employee’s eagerness to work without pressure (Oyadele, 2011). The extent to which nurses are motivated in their work depends on how well they are able to perform their duties. Motivation is expected to have a positive effect on quality performance. Nurses who are characterized by a high level of motivation show a high work and life satisfaction (Comber & Barriball, 2007). It leads to high level of initiative and creativity from employee. Where monitoring is difficult, motivation is extremely important for ensuring high quality performance.
There are two types of motivation, intrinsic and extrinsic. Intrinsic motivation is determined by an interest or enjoyment in the work itself, and it develops within the person rather than relying on someone else. Intrinsic motivation is better and cheaper way to motivate workers (Scheltz, Schultz & Duane, 2010). Intrinsic motivation includes recognition for work done, personal accomplishment, relationship between boss and subordinate, relationship with colleagues, achievement, increased responsibility, growth through self-development. On the other hand extrinsic motivation is a reward in form of regular promotion, pay raise, supervision of subordinates, a cash bonus, fame, a gift, interpersonal relationship, good working condition. In other words, it is a tangible reward in recognition of employee performance. However, the major problem with most extrinsic motivation programme is that the programme has to be continually repeated (Adoni, 2007). In addition, any motivation produced by extrinsic factors wears off and it gets worse if over used (Adoni, 2007).
Performance is carrying out of activities to meet responsibilities according to standards. It is an indication of what is done and how well it is carried out (Winch, Bhattacharyya, Debay, Sarriot, Bertolin & Morrow, 2009). It is the accomplishment of a given task measured against established standards of accuracy. It is the fulfilment of an obligation in a manner that releases the performer from all liabilities under contract. Nurses performance is determined during job performance reviews with an employer taking into account factors such as leadership skills, time management, intelligent, skills, punctuality, reliability, institution policy and services rendered to evaluate each nurse on an individual basis (Letvak, & Buck, 2008). Job performance reviews are often done yearly and can determine whether the nurses are due for promotion or not. Performance of nurses in a hospital depends on the knowledge, skills and motivation of individual nurses where hospital management provides good working conditions. The expectation of the general public about nurses is to render the desired duties in terms of health interventions, which is a concern for the World Health Organization (WHO) and policy makers (High level forum 2010; World Bank 2005).
Improving performance and productivity of health care workers in order to enhance the efficiency in health interventions, is a major challenge for hospitals in Nigeria. Human resources for health (clinical and non – clinical) staff are paramount as staff are the most important asset of health systems.
According to Mccourt and Awase (2010), good working conditions and other motivational factors support the performance of employees and employers should take advantage of it. It is important that a nurse manager knows the primary needs of her nurses to manage and address them toward great job performance in the work place. When their needs are met, nurses are likely to take responsibility for their performance and they will perform well to achieve the nursing goals.
It is therefore necessary to empirically investigate perceived motivational factors among nurses in two selected tertiary health institutions in Rivers State.
Statement of Problem
The quality and efficiency of health care services depend on the availability of skilled, competent health professionals when and where they are needed. Recent developments in health have heightened the need to motivate employees (Ararabi, Subramanian & Akeel, 2013). Health care workers need appropriate training to deliver the required standard of service. The public health sector system in Rivers state consists of two tertiary Hospitals, the University of Port Harcourt Teaching Hospital, Port Harcourt (UPTH) and Braithwaite Memorial Specialist Hospital (BMSH). The hospitals offer services for Primary, Secondary and Tertiary care resulting in influx of patients in the hospital thereby resulting in work overload among the nurses. Anecdotal reports from the hospitals indicate that nurses are overworked, demoralised, show signs of burnout and complain about no recognition for their contributions. Although nurses’ motivation is a significant element of health system performance, it is largely under studied (Awases, 2010). Issues of motivational factors have not been adequately addressed in Nigeria generally and more especially among nurses. Nurses have major roles to play in providing timely, quality health services as they constitute 80% of the health workers (WHO, 2011).
There is need to determine the perception of motivational factors among nurses in the two selected hospitals in order to improve their performance in the work place.
The Purpose of the Study
The aim of this study was to determine job – related motivators among nurses in two selected tertiary health institutions in Rivers State.
Specifically, the objectives of the study are to:-
- Determine if promotion opportunities are perceived by nurses as a job related motivator.
- Determine if monthly payment of salaries is perceived by nurses as a job related motivator.
- Ascertain if recognition of work done is perceived by nurses as a job related motivator.
- Determine if personal accomplishment is perceived by nurses as a job related motivator.
- There is no significant difference in the perceived job-related motivators of nurses based on their rank.
- There is no significant difference in the perceived job-related motivators of the nurses based on their educational qualification.
- There is no significant difference in the perceived job-related motivators of nurses based on years of experience.
Significance of Study
This study is designed to have a better understanding of perceived motivational factors among nurses in University of Port Harcourt Teaching Hospitals and Braithwaite Memorial Specialist Hospital, Rivers State. The findings in this study will have both practical and theoretical contributions in the hospital specifically and among nurses generally by improving on what motivates them. The results will assist nurse managers in developing motivational factors to improve performance of their staff. It will also be of immense benefit to the hospital management in improving performance of the health workers. Theoretically, findings from the study will contribute to existing knowledge on perceived motivational factors among nurses in the two selected hospitals.
The Scope of Study
This study is confined to Nurses in University of Port Harcourt Teaching Hospital and Braithwaite Memorial Specialist Hospital (BMSH) Port Harcourt, Rivers State. These nurses include nurses within the ranks of Assistant Chief Nursing officers, Principal Nursing officers, Senior Nursing Officers, Nursing Officers I & II that are working in UPTH and BMSH Port Harcourt. The study is confined to determine regular promotion, payment of salaries, recognition for work done, feeling of personal accomplishment and Demographic differences in the two selected hospitals.
Operational Definition of Terms
Job related motivators: refer to nurses’ opinion on factors that enable them to put in their best in the work place. Such factors examined in this study include: promotion opportunities, regular payment of salaries, recognition for work done and feeling of personal accomplishment.
Regular payment of salaries: refers to monthly payment of salaries, payment of fringe benefit e.g. increment, Christmas bonus at year ending.
Promotion Opportunities: refer to nurses being promoted based on objective performance appraisal of staff, attainment of additional qualification recommended by the supervisor and according to civil service regulation of having spent three years in a position.
Recognition of work done: refer to commendation of staff for good work done. This could be in form of praises, thank you, receiving a trophy, best nurse of the year, giving higher responsibility.
Personal accomplishment: refer to the satisfaction derived by the nurse as a result of the job she has performed or still performing Example: Opportunity to use one’s initiative, when patients are discharged home in good condition etc.