The Motivations to Nurse, Article Review Example

Introduction

This essay reviews a current research paper, specifically Newton et al. (2009). The structure of this essay is first to summarize the paper itself, considering its problem statement, identifying the methodology used, followed by summarizing their findings and the limitations of the study.  Once the paper is reviewed, it is assessed to identify the significance of this paper for nursing training, followed by a comparison of the results of Newton et al. to the results of other researchers in similar studies.  Finally this essay draws conclusions about the importance and implications for clinical and educational practice based on the summation of all evidence considered, including the subject paper and the other comparison papers identified in this essay.

Summary of the Paper

Newton et al. (2009) attempted to discern the motivations of nurses at various levels in their careers, beginning as nursing students, through career stages of registered nurses, nurse managers, and directors of nursing.  The authors noted that nurse retention within individual healthcare organizations and within the profession as a whole is a significant problem throughou the world (Newton et al., 2009).   With the aging of the population, the need for quality nurses is increasing while more and more are leaving the field. Understanding the motivations nurses exhibit for entering the profession is one key for understanding how to recruit and retain them.

The study attempted to understand what motivates individuals to choose nursing as a career by doing  a  multi-longitudinal study of individuals at different stages in their careers from nursing student to directors of nursing.  The study consisted of qualitative semi-structured interview processes using an ethnomethodological approach. Students were interviewed five times each, registered nurses were interviewed four times each, and nurse managers and directors of nursing were interviewed  three times each.  The focus on interviews included work history, experiences in nursing practice, and so on.  Management participants were asked about their contributions to the nurses working for them and sense of control and efficacy within the workplace.  Studies were transcribed and analyzed for themes.

Newton et al. (2009) identified four key motivational themes that ran through all levels of nursing professionals: the desire to help others; a sense that nursing is about caring about other people; the belief that nursing corresponds to a sense of achievement in that they contribute to the well being of other people; and a sense that nursing creates a self-validation, in that it contributes to the individual’s need to feel good about themselves and to do something that was appreciated and helpful to other people.  The authors noted that nurses at all levels, from student to directors of nursing, expressed similar themes in their responses, and that their motivations appeared as a complex mixture of both intrinsic and extrinsic motivators. The key limitations noted in this study were that the data derived from a single healthcare organization affiliated with a single hospital in Australia. In addition, the data collected derived from self-reports, which is an issue in such ethnomethodological studies.

The significance of Newton et al., is that it identified a complex mixture of motivations for nurses that applied at all career levels.  Primarily, the authors noted that both caring and the need for external validation are key to choosing nursing as a career. Given the rate at which nurses drop out of the profession, the authors note the importance of recruiters and managers recognize these fundamental motivations in nursing students and in professional nurses.

Comparison to Findings in Other Studies

A number of other studies have investigated the motivations of nurses and how best to manage them to retain them in the profession.  In this section, some of the more recent studies will be reviewed in the context of Newton et al. (2009).

Mackintosh (2007) investigated the motivations of nurses to work on a surgical ward using a semi-structured qualitative interview similar to the approach used by Newton et al. (2009).  In this study, the focus was on one of the popular areas nurses chose for careers, specifically surgical wards, to understand why they opted for that particular specialty.  The study was quite small, only 16 registered nurses, and a thematic analysis found that the elements that motivated this career option included the fast pace and rapid turnover of surgical wards. In addition, Mackintosh found that nurses actively rejected the prospect of working with long-term chronic illnesses, particularly those in which the patients were not likely to recover.  Mackintosh noted that such patients were considered both depressing and unrewarding because the nurses had a primary motivation of making patients better, and chronic, incurable conditions were unlikely to feed that motivation (Mackintosh, 2007).

A study of newly graduated nurses in Belgian investigated the characteristics of the jobs they sought and the types of work environments they preferred (De Cooman et al., 2008). As with Newton et al.(2009), the authors noted that the shortage of nurses provided the rationale for the study.  The Belgian study came to similar conclusions as did Newton et al. (2009), in that key motivating factor in these young nurses included altruism.  They also noted that male participants were more concerned with career progression, autonomy, and the prospect of developing into nursing management type of positions, while women participants were more focused on the interpersonal aspects of nursing, similar to the factors of helping other people and caring that Newton et al. defined (De Cooman et al., 2008).

Gambino (2010) studied how the motivation of registered nurses to enter nursing as a career affected their commitment to their occupation and their intentions to work as a nurse until retirement.  This study was a quantitative survey  designed to elicit reasons for poor retention rates within the profession.  Gambino established a theoretical framework in which an altruistic or analytical motivation was presumed to influence the educational commitment needed to become a licensed professional.  That motivation, plus a commitment to the occupation was presumed to determine the individual’s intention to remain.  Gambino noted that attrition of nurses is high enough to be “alarming” (p. 2539), and that the survey results showed that older nurses and those with higher levels of commitment were more likely to intend to work there through retirement.  Further, Gambino found that the specific types of motivation (i.e., altruistic or analytic) had no significant influence on their intentions to remain in the career.

Lephalala et al. (2008) studied the work characteristics that influenced nurses’ job satisfaction in England in the context of private hospitals.  This study used quantitative methods in a self-reported questionnaire to determine those factors.  The authors noted that with the exception of salary, most of the nurses surveyed were reasonably satisfied with their work environment such as administration, supervisors, and co-workers.  In terms of internal motivations, the nurses cited issues with lack of promotions, lack of opportunities for advancement, and lack of empowerment in terms of decision-making and policy-making.  These authors found that management at these hospitals could improve nurse motivation by establishing consistent promotion policies, establish a credible salary policy, and by including nurses in the decision-making processes in the hospitals (Lephalala et al., 2008).

Dave et al. (2011) also investigated the intrinsic/extrinsic rewards of nursing careers by surveying nurses in the Southern U.S. about their perceptions of the rewards offered by their hospitals.  This quantitative study  found that when intrinsic rewards were not met, even in fairly minor ways, dissatisfaction with extrinsic rewards was much higher.  Thus, the key driver for job satisfaction was providing suitable intrinsic rewards; when those were properly satisfied, the likelihood of dissatisfaction with external issues (salaries, promotions, etc.) significantly decreases (Dave et al., 2011).

Male nurses were the subject of one study in Taiwan.  The authors investigated the impact of job stress and motivation on the rate of occupational burnout for male nurses (Hsu et al., 2010).  This study was also a quantitative survey of 121 male nurses.  The study found that occupational stress was strongly associated with burnout, and concluded that such stress and burnout almost certainly impacted the quality of care. Thus, these authors recommended that management take steps to reduce such job stresses as work overload, poor or high-conflict organizational interactions, and role conflicts in order to reduce burnout for these nurses.

A study by Vevoda et al. (2011) surveyed more than 650 Czech nurses to determine their values and motivations in an attempt to discern appropriate retention strategies.  Vevoda et al. noted that more than 40% of European nurses were reportedly dissatisfied with their jobs.  The goal of this study was to determine the issues of greatest importance. Key factors reported were those of salary and job security, while prospects for job advancement were least important to these Czech nurses.  Other factors that were poorly satisfied by the nurses’ work environments included basic personal recognition for their jobs and a lack of cooperation within the work environments (Vevoda et al., 2011).

Management of nurses was studied by  Curtis and O’Connell (2011) to determine what leadership attributes best increase motivation and empowerment in nurses.  The authors considered transactional leadership and transformational leadership. In the case of transactional leadership, specific job tasks are reduced to a transaction between management and worker, in which a specific task is associated with a specific reward (such as a salary).  Transactional leadership essentially describes the workplace as a capitalistic marketplace.  Transformational leadership, on the other hand, inspires workers with a vision and inspirational motivation through charisma and providing reward that support individuals’ needs (Curtis & O’Connell, 2011).  The authors note the importance of establishing a work environment that inspires creativity in the nurses, and that encourages nurses to participate in the decision-making process.  Curtis and O’Connell also note the importance of enhancing work practices through enrichment and enlargement as key methods of enhancing the quality of work life (QWL).

Conclusion

The Newton et al. (2009) study provided insight into the motivations that urge individuals to take up nursing as a career. Newton et al. found that nurses at all stages of their careers tended to place high values on themes of caring, a sense of achievement, a contribution to the well being of others, and a sense of self-validation. These themes were, in general, supported by the other studies surveyed here, including Machintosh  (2007), and De Cooman et al. (2008). Of particular interest was the Gambino (2010) study in which the particular motivations for entering the field did not have a strong impact on the nurses’ intentions to work as a nurse until retirement; occupational commitment was the key factor found in that study.  From a managerial perspective, Dave et al.(2011) found that meeting intrinsic rewards was critical to increasing nurse job satisfaction; if those were not satisfactory, then dissatisfaction with extrinsic rewards was substantially higher.

References

Curtis, E., O’Connell, R. (2011). Essential leadership skills for motivating and developing staff. Nursing Management—UK, 18 (5), 32-35.

Dave, D. S., Dotson, M. J., Cazier, J. A., Chawla, S. K., Badgett, T.F. (2011). The impact of intrinsic motivation on satisfaction with extrinsic rewards in a nursing environment. Journal of Management & Marketing in Healthcare, 4(2), 101-107.

De Cooman, R., De Gieter, S. Pepermans, R., DuBois, C., Caers, R., Jegers, M. (2008). Freshmen in nursing: Job motives and work values of a new generation. Journal of Nursing Management, 16(1), 56-64.

Gambino, K. M. (2010). Motivation for entry, occupational commitment and intent to remain: A survey regarding Registered Nurse retention. Journal of Advanced Nursing, 66(11), 2532-2541.

Hsu, H., Chen, S., Yu, H. Lou, J. (2010). Job stress, achievement motivation and occupational burnout among male nurses. Journal of Advanced Nursing, 66(7), 1592-1601.

Lephalala, R. P., Ehlers, V. J., Oosthuizen, M.J. (2008). Factors influencing nurses’ job satisfaction in selected private hospitals in England. Curationis, 31(3), 60-69.

Mackintosh, C. (2007). Making patients better: A qualitative descriptive study of registered nurses’ reasons for working in surgical areas. Journal of Clinical Nursing, 16(6), 1134-1140.

Newton, J. M., Kelly, C. M., Kremser, A. K., Jolly, B., and Billett, S. (2009). The motivations to nurse: An exploration of factors amongst undergraduate students, registered nurses, and nurse managers.  Journal of Nursing Management, 17, 392-400.

Vevoda, J., Ivanova, K., Kanladalova, M., Mareckova, J. (2011). Motivation and job satisfaction of general nurses working in out patient hospital departments from the perspective of Hertzberg’s two-factor motivation theory. Conference Proceedings of the IV International Conference of General Nurses & Workers Educating Paramedical Staff, 2/8/2011, 154-163.