A good reward system is needed to motivate employee of an organization. The aim of this research is to analyse the factors affecting nurses' loyalty and what increase the job satisfaction and motivation of the nurses in Changi General Hospital Singapore. The impact of three dependent variables rewards, empowerment and management on the dependent variable nurses' loyalty is studied. The research conducted shows that there is a strong positive relationship between rewards and motivation among the staff nurses. I postulate that a decrease in motivation decrease job satisfaction and these cause a decrease in nurses' loyalty. It was also concluded that rewards have a greater impact on motivation of nurses than adjusting workload and how they are manage. There are findings of significant differences in comparison of means with respect to gender, age group, marital status, working duration, shift work and salary.
As we are living in the 21st century standards of living in Singapore have been increasing and again looking at a nursing shortage. This is an immediate and on-going concern this is also the reason for choosing nurses for this research as this profession is being emphasis and in demand. As the demand for more intensive and technologically advanced medical care is needed for children and our aging population, we will need even more nurses, but we have lesser nurses entering the work force since. Even when we have adequate numbers of nurses entering the workforce. We will still have challenges recruiting nurses who want to work in required specialized areas. Therefore it is necessary to maintain a healthy amount of health care provider to sustain the quality of services provided. Good health care providers should also be recognised and be rewarded for their service, knowledge and performance.
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In many countries we can easily find a high turnover rate for registered nurses due to dissatisfaction in their job. Job satisfaction is in regard to one's feeling or state of mind regarding the nature of their work. Job satisfaction can be influenced by a variety of factors which are one's relationship with their supervisor/management, the amount of workload tasked, degree of fulfilment in their work, the rewards that comes fairly with the amount of effort put in and more. Job satisfaction in staff nurses should be of great concern to any organization. Nurses hold the majority of positions in most health care settings, and replacement of licensed personnel is costly and time consuming. Therefore the with the current shortage of nurses and the anticipation of worsening condition there is a need to analyse the sources of dissatisfaction in the health care setting. I reviewed several sources and drew out pertinent information. Following the discussion of literature findings is a summary including suggestions for further research.
Motivation is often regarded as the underlying cause of behaviour as it arouses and directs attention and energy for behaviour (Franken, 2007; Petri & Govern, 2004). It manifested in the choice or direction, strength and persistence of behaviour. For example, weather a staff nurse chooses to direct energy to help or ignore a patient, how much effort the nurse puts in to help, and whether the nurse gives up when the situation gets difficult, reflect the motivation of the staff nurse. Motivation is highly dynamic and highly situation-dependent. A nurse motivation may change after he/she has decided to help the patient and there may be many factors that can affect the change and level of motivation. Some of these factors will be clearer wen the theories of motivation are presented later. In recent years, researchers have recognized the important role of emotions and are studying its relationship to motivation. Nevertheless, the theories still provide useful frameworks and models for the management to use when they manage their employees.
The basic objectives of carrying out this research were;
To analyse the link between motivations and staff retention
To review and improve job satisfactions
To provide recommendations to retain good performers
2.1 What is motivation?
The most important capital agreed by all in our modern business world is often considered to be the employees and they in turn need good management. Good management of employees consequently can be translated as satisfying employees who are motivated to perform in an improving way.
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Psychologists have identified two broad categories of underlying causes of human behaviour, approach and avoidant. For approach causes, people are motivated to do things because of something they need or desire. Examples include food, money and independence. For the avoidant causes, people are motivated to do to prevent, avoid or escape something. Examples include failure, a bad smell and disapproval from loved ones.
According to Mullins (2002) and Daft (2003) motivation is made up of forces internal or external which direct the way and persistence of action through enthusiasm. According to Daft (2003), employee motivation affects productivity and consequently profitability of the company. Therefore, "a manager's job is so to speak to channel motivation towards he accomplishment of organisational goals" (Draft, 2003 p.546). Currently there are many motivations theories, which may be used by employers in order to affect employees' performance. Motivational theories are typically classified as "content base" and "process base" theories. The former focuses on the causes of behaviour which have been labelled as "needs" and "motives" have Maslow's hierarchy of needs theory (1943), McClelland's acquired needs theory (1961) and Herzberg's two-factor theory (2002) fall under this category. The latter focuses on the process in which the behaviour is energized and redirected. Reinforcement theory (1904-1990), Vroom's expectancy theory (1964) and Adams' equity theory (1965) fall under this category.
Hierarchy of Needs (Maslow theory, 1943)
In 1943, Maslow discover that individual development and motivation with the hierarchy of needs. After Maslow discovery, many theories were then elaborated but with differences. Maslow's theory introduces that employees are motivated by several needs. According to his theory human beings have different needs, which can be classified and placed in a pyramid starting with those, which are more essential. These needs are physiological needs, safety needs, belongingness and love needs, esteem needs and self-actualisation needs. Employees want to satisfy these needs, firstly those which are the lowest in the hierarchy and afterwards to continue satisfying those higher in level. A necessary requirement to continue to the next step is the first satisfaction of the previous need.
To correlate the hierarchy of needs into company's demands it is that for physiological needs require income in order to be satisfied. Safety needs has to do with safe job and job security, belongingness needs reflect the desire to participate in a work group and to have a positive relationship with supervisors. Esteem needs are related with the need for recognition and increased responsibilities. Lastly, self-actualisation needs reflect the opportunities for training and advancement (Mullins, 2002 & Daft, 2003). As follows, many employees are motivated by job security. Employees need to feel freedom of fear, to feel safe in the workplace and not daily anxiety for what is going to happen the next day. Additionally employees need to feel that they belong to the company and they are part of it. In this way employees will strive to work harder because they feel they are part of the organisation.
Two-factor Theory (Herzberg's, 2002)
A different approach has been presented by Herzberg with the two-factor theory (2002). His theory is actually based on Maslow's hierarchy of needs but he distinguished needs in hygiene factors and motivators or growth factors. He highlighted that when a company hygiene factor do not exist. Examples are salary, job security, working conditions, level and quality of supervisions, company policy and administration and interpersonal relations. If these exist employees are dissatisfied but this does not mean that employees are motivated or satisfied. This is because based on his research the opposite of dissatisfaction is satisfaction only semantically and not when it comes to understanding the behaviour of people in their jobs. (Herzberg, 2003)
Acquired Needs Theory (McClelland's, 1961)
"The McClelland's acquired needs theory proposes that certain types of needs are acquired during the individual lifetime. In other words, people are not born with these needs but may learn them through their life experiences" (Daft, 2003, p.553). There are three needs that are most often studied which are firstly the need for achievement, which is defined as the need to accomplish something difficult, to master physical objects, human beings or ideas, to attain high standards and to surpass others (Huczynski & Buchanan, 2001). Secondly the need for affiliation, which is defined by the need to form close personal relationships, avoid conflict and establish warm friendships (Draft, 2003, p.554). In addition, people with higher need for affiliation prefer to spend more time in social relationships and joining groups (Huczynski & Buchanan, 2001). Thirdly some people also have the need for power. People who have high need for power are people who desire to control and influence others and have authority over others (Daft, 2003).
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Expectancy Theory (Vroom's, 1964)
According to Mullins (2002), Daft (2003) Vroom's expectancy theory (1964) refers to employees' belief that they are capable of influencing their performance through increasing effort. Expectancy theory is based on the idea that people try to achieve certain outcomes from their behaviour over others because they can anticipate that these outcomes can give them feeling of satisfaction. The anticipated satisfaction from an outcome to which they are expected to lead. The valences of outcomes derive from employees' instrumentality. Instrumentality reflects to employees' knowledge that an outcome in performance will result in an increase in rewards. Therefore employees will try to perform well even because they derive satisfaction through this and without thought to expect consequences of their actions or because their outcome (performance) will lead to other outcomes (pay, fringe benefits, promotion) which give them satisfaction (Mullins 2002).
Equity Theory (Adam's ,1965)
Adam's equity theory suggests that "people are motivated to seek social equity in the rewards they expect for performance" (Daft, 2003, p.555). Based on Huczynski & Buchanan, (2001) equity holds that motivation is a function of fairness in social exchange. People who are motivated by fairness need the input of their contribution to be equal with the output, which is pay, recognition, benefits and promotions. In any case that an employee has the feeling of inequity based on Adams can have different types of reactions. Examples of feeling inequity are increasing or decreasing the level of their input which is performance. Trying to change the outcome which is pay but without to change the input. Trying to avoid the existence situation by requesting for a transfer out or even resigning from the organisation. Trying to influence the others inputs and affects their input and outcome in order to achieve equity (Mullins, 2002).
2.2.1 Factors Affecting job Satisfaction
(Extracted from Harvard Business review, 2003, p.56)
Herzberg theory provides a strong link between job satisfaction to motivation and performance. It shows that performance can come as an emanation of feelings like achievement, advancement, growth, which are related with job satisfaction and motivation. This is associated with the early human relations approaches. According to Mullins (2002) Luthans provided that there is no strong link between job satisfaction and productivity performance. Finally, Bassett suggests that research studies have found that only a limited relationship between job satisfaction and work output. Additionally, Herzberg (2003) emphasized the importance of job enrichment and he separated it from job enlargement. The term job enlargement to both Mullins (2002) and Herzberg (2003) is to make the job structurally bigger and the term enrichment includes increased responsibility and involvement, opportunities for advancement, and the sense of achievement exactly what Herzberg considered as motivator factors, achievement, recognition, responsibility, nature of work, personal growth and advancement.
From here we can also see a strong positive link between job satisfactions to work load tasked. If workload is increase and yet no involvement, opportunities for advancement, and the sense of achievement is achieve employees might feel there is no satisfaction leading to feeling demoralize and affect the employee loyalty to the organisation. To the employee this also reflects that the management is not taking good care of them and they might feel no involvement and no relationship forged with the management. This absence causes dissatisfaction due to the quality of supervision given to him/her is insufficient which may causes them to feel a sense of insecurity for their job. Herzberg (2003)
Therefore nurses' job satisfaction is very important because the current nursing shortage and high turnover is of great concern in many countries because of its impact upon the efficiency and effectiveness of any health-care delivery system. Recruitment and retention of nurses are persistent problems associated withÂ job satisfaction. From the graph shown above shows the factors that usually contribute to job satisfaction and dissatisfaction. For job satisfactions are job achievement, work recognition, nature of job scope, job responsibility, career advancement and potential career path growth. For job dissatisfactions are largely due to company polices and administration, management supervision, relationship with supervisors, working conditions, salary, relationship with colleagues, personal lifestyle, relationship with subordinates, job status and job security. All these factors under job satisfaction can be further divide under rewards, workload and management shown in the Theoretical Framework shown in chapter 3.
To reemphasis the two theories that have been important in the development of an understanding of job satisfaction in nursing and Maslow's hierarchy of needs theory and Herzberg motivation and hygiene growth needs theory. Maslow's identified two types of needs, deficiency needs which are physical, safety and belonging and growth needs which are self-esteem and self-actualization. Herzberg two factors theory consist of intrinsic factors or motivators that promote job satisfaction and extrinsic factors of hygiene factors that cause job dissatisfaction. They are also use to understand job satisfaction in nurses' early career and from most of the motivation theories stated above it ties down to these three main factors that affect nurses job satisfaction which are rewards, management and workload.
For example salary will fall under rewards which also falls under the primary/basic needs physiological needs of Maslow's hierarchy of needs. Maslow (1943) For an example a nurse just have to compare the effort he/she put in to the amount of pay drawn which might not even be able to sustain the high living standards of the country they live in. In this way tendency of him/she feeling dissatisfied will be form. This example can also be link to the Adam's equity theory (1965) whereby the government sector nurses comparing their pay drawn to those working in the private sector to the amount of effort require to put in they will natural feel the imbalance and lack of fairness casing job dissatisfaction. Under types of rewards there are also monetary rewards which are awarded to personnel by the organization in form of cash, or through cheque or some other way of financial transaction for achieving goals, providing best quality, providing outstanding performance in difficult situations. Monetary rewards are also called tangible rewards. The other type of rewards is non-monetary rewards. Some examples of non-monetary rewards include certificates, an appreciation like thank you from manager or supervisors, flexible schedules or an off day and many more. Non-monetary rewards are also called intangible rewards.
(Extracted from Harvard Business review, 2003)
Manville and Ober (2003) emphasise the need for empowerment through a democratic system. The core of modern business is an employee with intelligence, understanding skills and experience which is called knowledge employee. Organisations which demand this kind of employee, needs to face them as their central managerial challenge. Nurses definitely falls under knowledge employee as their job scope comprises of issuing of medication, injections, CPR which is also resuscitation during emergency cases. From the diagram above we can also there is a close link between empowerment and workload which links to motivators such as intrinsic rewards like recognitions and achievement. This will build up an employee self-esteem and self-actualization and in a long run he/she will find a sense of belongingness to the organisation and have lesser dissatisfaction with the current work. Giving selected employee empowerment will create a sense of shared ownership in the organisation. This way it is like motivating them to give their best in terms of abilities and performance, it is also a both party win, win situation. Beyond doubt, this is not just a prescription for modern management because this actually means changes in organisational and managerial values and culture, but promotes a system where motivated employees can co-operate for better organisation result.
Different managerial styles and practices at the organisational unit level which is ward can have direct bearing on nurses' satisfaction. This is because for example of working overtime due to lack of manpower issues will causes the employee social needs to decrease as activities planned ahead with family will need to be cancelled or even unable to fetch kids from school. This also affects the lifestyle of the employee. The lack of manpower is a management issues by itself. Like highlighted an work over load issues might affect interpersonal relationships among nurses and other medical staff. It will also affect the ward cohesiveness. It is also clear that money is not the only means for motivation, it is much more than money. Longstanding factors that can motivate people to do their very best are promotion and growth in the organisation and interesting work. According to Herzberg's motivator and hygiene (2002) the most successful method of motivating and increase job satisfaction is to build challenge and opportunity for achievement into the job itself.
Moreover, McClelland's theory (1961) suggest that challenging tasks with clearly attainable objectives, timely feedback and more responsibility for innovation assignments creates higher job satisfaction and higher achievement needs. Through the opportunity for promotion and training a company can strengthen employees' feelings like advancement, achievement and recognition. Promotion and training increases the cost of organisation, short term but well-motivated employee with high job satisfaction will over all be more worth as it cover long-term and might influence others. All these stated require close monitoring and a good management which comprises of more factors. One of the more important factor is having constant feedback from the employees pool which also means good relationship with them.
Research Methodology Design
The aim of the research is to investigate how nurses in Changi General Hospital Singapore are motivated in order to increase their job satisfaction.
"A discipline or profession is established by developing a body of knowledge which is unique - that body of knowledge is produced through research." (Amaratunga al, 2002)
According to Amaratunga et al, (2002) research is important in both business and academic activities but there is no consensus in its definition. This is because research means different things to different people. Based on Amaratunga et al, (2002) there is agreement only in some points that research is a process of enquiry and investigation, it is systematic and methodical and it improve and increases knowledge.
3.3 Theoretical Framework
Fig 1. The Theoretical Framework
The Theoretical Framework was designed by keeping in mind Herzberg's (2003), Maslow's (1943) and McClelland's (1961) work which come out with factors that affect motivations of employee which will then affect the job satisfaction level of employee. These stated factors shown the Fig.1 is selected as they are more crucial in affecting nurses' job satisfaction level in their career. Drawn from the theories, with the employees having the intention of receiving rewards may it be tangible or non-tangible will influence employees to put more effort, determination and focus on work showing their motivation to do something. Job satisfaction then becomes a part of motivation when they know that their organisation is valuing him willing to empower them if they prove their worth and providing sufficient support and communication, in return the employee will give his/her best back to the organisation.
Tool for data collection and sample size
The tool used for data collection for this research will be a survey. And for the purpose of doing surveys questionnaire was designed. The questionnaire will be distributed by email and some were place in the lounge. In order to get a higher response rate there were also several follow-ups will be send. Response rate that will be expected to receive back is minimally a 50% which is 75 out of the sample size of 150 nurses must be receive back both through e-mails and paper format. Results will then be randomly picked using the website random selection generator at http://www.random.org/. Surveys are then numbered 1 to 75. If the random number generator happens to pick a number twice it will be regenerated. An Microsoft soft excel file will also be create to house all the data collected to calculated the average results and doing of correlation of data.
Design of Questionnaire
The research questionnaire consists of two parts. In the first part it consists of personnel information of categories such as gender, age, working experience, marital status, years in current job and salary. The second part was designed for the collection of data about the variables such as rewards, empowerment, management and job satisfaction.
In conclusion, there are many factors that will contribute to job dissatisfaction in the work place such as hospital. There will be many variables within each factor make achieving job satisfaction for every individual a very difficult task. Recognition of frustrations, such as turnover, lack of internal empowerment, workload increase and decreasing of external sources of stress will decrease dissatisfaction in the health care setting.
Issues concerning job satisfaction, potential for burnout, as well as effect of burnout on patients, expanded knowledge and better understanding of productivity, and, sources of empowerment in the health care setting should continue to be investigated. Having to improved job satisfaction will results in lesser turnover rate, better quality patient care, less physical and mental injuries to health care staff, and over all improving the of entire organization effectiveness. Extrinsic work values such as, job security, salary, fringe benefits, and work schedules, are also considered to be important in job satisfaction. Restrictions in scheduling and limited availability of time off promote frustration and dissatisfaction.
4.2 Possible Outcome/ Analysis
Some possible outcome will be that we will see the findings indicated that there is a stronger correlation between job satisfaction to rewards follow by management which is also organisational support then empowerment. Nurses will also be more likely to be committed to the organisation when they are provided with a proportionate amount of job autonomy and equitable workloads. On top of that with the perception that the organisation focusing on competitive salaries may also contribute to burses commitment to the organisation. We will see that when motivation (rewards, management and empowerment) decreases it will cause a drop in job satisfaction and when both of these decrease it will cause the affect the loyalty of the nurses resulting an increase in staff turnover rate.
4.3 Limitations & suggestion for future research
A recommendation would be to conduct further studies with nurses regarding their commitment to the organization, without including their current management support. To have employees address questions such as their employers as opposed to themselves, or in addition to them this may result in a total different outcome. In addition for recommendation the management can also consider practicing using the (IDP) Individual development process guide to help employees gain sense of belongingness, improve their self-esteem and self-actualisation. It is through having selected acceptable mangers/supervisors do coaching conversations with their employee, step by step guide them on their roles and responsibility next pen picture and lastly come out with goal setting listing out the problems and pitfalls that will be face equipping them with critical and creative thinking skills. This will allow them to feel a sense of job security, valued and meet their self-actualisation needs. This also helps in improving the organisational effectiveness by training them to be good preceptors, educators, mentors and clinical advisor.