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http://jnep.sciedupress.com Journal of Nursing Education and Practice 2019, Vol. 9, No. 9
ORIGINAL RESEARCH
Factors affecting nurses’ work motivation level at a
governmental hospital: A cross-sectional study
Reem A. Baljoon∗1,2, Hasnah Banjar3, Maram Banakhar3
1King Faisal Special Hospital & Research Centre, Jeddah, Saudi Arabia
2Science of Nursing Administration, King Abdulaziz University, Saudi Arabia
3Nursing Administration, Faculty of Nursing, King Abdulaziz University, Saudi Arabia
Received: December 10, 2018 Accepted: May 4, 2019 Online Published: June 6, 2019
DOI: 10.5430/jnep.v9n9p25 URL: https://doi.org/10.5430/jnep.v9n9p25
ABS TRACT
Background and aim:
Nurses are working in different healthcare organizations; each healthcare organization has different
organizational resources. Therefore, factors affecting nurses’ work motivation are varied among nurses. This study aimed to
identify factors affecting nurses’ work motivation levels at a governmental hospital in Saudi Arabia.
Methods:
A cross-sectional design was conducted by recruiting registered nurses (n = 280) who worked for at least one year of
experience. The survey was distributed among registered nurses working in one governmental hospital in the Kingdom of Saudi
Arabia to assess nurses’ work motivation level and to identify the affecting factors.
Results:
This study showed that nurses’ work motivation level is affected by several personal and organizational factors. A
positive relationship was found between higher order need strength and shared values and nurses’ work motivation (intrinsic and
extrinsic). This study revealed that there is a positive relationship between pay, promotion, supervision, fringe benefits, contingent
rewards, co-workers, nature of work, communication and working conditions and nurses’ work motivation level.
Conclusions:
There is a need to enhance and promote the motivational strategies within the current study setting by providing sat-
isfactory remuneration, equitable benefits increase the chances of promotion and encourage supportive supervision. Additionally,
there is a need to create healthy workplace environment that support co-workers relationship.
Key Words: Nurses’ motivation, Work motivation level, Personal factors, Organisational factors
1. INTRODUCTION
Motivation is known as a drive that makes an individual
to seek out or achieve satisfaction of a need.
[1]
Moreover,
motivation was defined as determining the needs of the em-
ployee, implementing proper strategies and as the force that
energizes, guides, and maintains human behaviour.[2] In the
work context, motivation can be defined as “an individual’s
degree of willingness to exert and maintain an effort towards
organizational goals”.
[3]
Motivation is categorized into in-
trinsic motivation (IM) and extrinsic motivation (EM).
[1]
The
main difference between these two types is that the moti-
vational state where IM is internally derived “derives from
within the individual, inspiring him or her to be productive”,
while EM is externally derived “enhanced by the job environ-
ment or external rewards” to meet personal or organizational
goals.[1, 4]
Nurses’ work motivation level is affected by several factors.
These factors can be personal such as individual priorities
∗Correspondence:
Reem A. Baljoon; Email: remacute@hotmail.com; Address: King Faisal Special Hospital & Research Centre, Jeddah 21499,
Saudi Arabia.
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which involved shared values with hospital and attainment
of higher order needs that increase nurses’ work motivation
level.
[5]
Although the orientation of nurses’ motivation at
work depends on their individual priorities, the strength and
sustainability of both IM and EM depends on the shared
values.[6–8]
Generally, nurses are more likely to be autonomously moti-
vated, if their work allow them to accomplish satisfaction in
their needs for competence (i.e. productivity, knowledge and
skill use), autonomy (i.e. decision authority), and relatedness
(i.e. belonging to a team, good relationships with others,
respect and the trust of co-workers). Most motivations re-
ported among nurses were satisfied derived from a sense of
accomplishment followed by the desired to learn new things.
It was found that nurses working in general care wards or
in the middle of their career with the dominant personal
value “Benevolence” and high experience rate, reported to be
highly motivated in contrast to those with the dominant value
“Hedonism”, who used computers infrequently or with low
to medium experience rate.
[9]
Similarly, nurses with higher
score of competence and humanity reported higher level of
work motivation.
[5, 10, 11]
Likewise, nurses who reported a
higher level of shared values in their hospital and nurses who
conveyed a higher level of identification with the long-term-
care setting had higher levels of work motivation.[5, 12]
Furthermore, work motivation is affected by internal psycho-
logical states which built on the person priority of values and
needs drives from personal factors.
[5, 13, 14]
However, three
critical internal psychological states were found in the litera-
ture for IM incorporate experienced responsibility for work
results, a knowledge of the actual results of the activities and
experienced meaningfulness of the job.
[15]
Job meaningful-
ness was one of the most important motivating factors among
health service providers.
[16]
Moreover, a positive relationship
between job meaningfulness and work motivation level was
found in several studies.[5,17, 18]
In contrast to personal factors, nurses’ work motivation is
also affected by several organisational factors. Work en-
gagement is positively associated with intrinsic work mo-
tivation and with extrinsic work motivation.
[19]
While in a
further study, nurses confirmed that positive environment
and supportive supervision and management motivated them
to stay at their hospital.
[20, 21]
Additionally, interpersonal
relationships, social respect, communication, effective team-
work and feedback could promote motivation in several stud-
ies.[11, 20, 22–24]
In a more recent study, it was reported that having a clear
job description, clearness in responsibilities and tasks were
important motivating factors in both management and per-
formance aspect.
[16, 25]
Furthermore, career development
and learning opportunity, chance for continuing professional
development and growth had the highest ability to inspire
nurses in their profession.
[20, 23, 26–28]
Moreover, appreciation
and recognition from community as well as the recognition
and appreciation of a good job carried out by nurses could
be the main motivation factor.
[22, 29]
In addition, financial in-
centives were most important motivating factor that advance
nurses’ performance.[25, 28, 30]
Health care system in Saudi Arabia (SA) faces many chal-
lenges that may alter or compromise the quality of patient
care such as shortage in nursing staff, high turnover, severe
stress and burnout.
[31]
Moreover, in the context of SA, nurses
are working in different healthcare organizations, each health-
care organization has different organizational resources and
working conditions and therefore the motivation level and
factors affecting nurses’ work motivation are varied among
nurses in different healthcare organizations. Importantly,
the government of SA has a new direction of providing a
cost-effective healthcare services in 2030. Therefore, due
to the vision of 2030 and the current economic changes that
noticed within the kingdom of SA in 2017, this resulted in
several limitations and changes within the hospitals’ human
resources and hospitals’ budgets. Thus, nursing mangers are
limited in delivering extra financial incentives that could mo-
tivate nurses to perform better.
[17]
Furthermore, nurses’ work
motivation level is varied not only according to the working
context of the healthcare organization; however, it is varied
in the time of change. Thus, in this period of significantly fi-
nancial restraint and global shortages of nurses, it is vital for
health care managers and administrators to be aware of the
factors that affect work motivation.[32] Therefore, this study
aimed to identify factors affecting nurses’ work motivation
levels at a governmental hospital in Saudi Arabia.
2. MATERIALS AND METHODS
2.1 Study design
A descriptive cross-sectional study design was conducted to
identify the factors affecting nurses’ work motivation level
in a governmental hospital.
2.2 Participants
Quota sampling technique was used to recruit all registered
nurses (RNs) who are working in the hospital with at least
one year of experience. In each unit, the researcher met the
department’s manager and introduced the aim of the study,
questionnaire and inclusion criteria. The list of names for
nurses who worked for one year and more in all the units
were provided to the researcher by the manager of each unit.
Nurses in each unit were selected based on their schedule
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which include their names. Then the researcher handed ques-
tionnaires in closed envelop to nurses after coordinating with
the department managers. All questionnaires were collected
in closed envelops in the following day. The sample con-
sisted of 280 registered nurses, 252 included staff nurses
while 28 were nurses holding managerial positions of grade
9 and above.
2.3 Setting
The study was conducted in a non-profit healthcare organisa-
tion that is well known as a reputable and accredited health
care organisation in Jeddah city at SA. This hospital is provid-
ing a tertiary care by serving local community with 500-beds
capacity for many years and has grown to become one of
the leading healthcare organisation in the Middle East. This
hospital has some unique characteristics such as high bed ca-
pacity, different culture, staffing and specialties. Importantly,
due to the limited financial budget in 2017, many nurses
resigned from this hospital leading to high turnover rate. In
this study setting, the data were collected in July 2017.
2.4 Instrument
The questionnaire used in this study composed of four sec-
tions: Section 1 included the sociodemographic information,
which was developed by the researcher; Section 2: This is
pertaining toward assessing the nurses’ work motivation level
by using The Motivation at Work Scale (MAWS).
[33]
MAWS
was validated in many languages and consist of 12 state-
ments measuring four variables which are: Intrinsic motiva-
tion, Identified regulation of extrinsic motivation, Introjected
regulation of extrinsic motivation and External regulation of
extrinsic motivation. MAWS used a seven-point likert scale,
ranging from 1 “Not at all for this reason” to 7 “Exactly for
this reason”. The items scored on likert scale, with scores
ranging from very low (1) to very high (7). Based on the
range of possible mean scores distribution of scores from the
instrument was as follows: Low motivation level (1-3.58),
Moderate motivation level (3.59-4.43), High motivation level
(4.44-7); Section 3: This section is aimed to assess nurses’
personal factors which consists of two different parts. First
part is Higher Order Need Strength Scale.
[34]
This scale mea-
suring nurses’ higher order need strength such as a stronger
need for achievement and self-actualization. This tool con-
sists of 6 statements, accompanied a seven-point likert scale
ranging from 1 “not at all important” to 7 “extremely impor-
tant”. Second part is Shared Values Scale
[35]
which consists
of 5 statements. This is Likert scale ranging from 1 “disagree
strongly” to 7 “agree strongly”. This scale is measuring the
degree to which nurses sharing the same values with the
organization; Section 4 aimed to assess organizational fac-
tors affecting nurses’ work motivation level which consists
of two different parts. First part is Job Satisfaction Survey
(JSS)
[36]
to measure motivational factors “organizational fac-
tors”. JSS consists of 36 statements with 9 facets (each facet
with 4 items) are Pay, Promotion Supervision, Fringe Bene-
fits, Contingent Rewards, Operating Procedures, Coworkers,
Nature of Work, and Communication. A summated rating
scale format is used, with six choices per item ranging from
1 “disagree very much” to 6 “agree very much”. Second
part is measuring working condition.
[35]
It consists of four
questions, which are working overtime hours and working
for other people are (multiple choice questions), working
schedule (forced choice), and opportunities for flexible work
time (multiple choices).
The content validity of the tool was confirmed by a jury opin-
ion that was taken by 5 experts from the faculty members at
one university in Jeddah city and the fields of leadership and
management in the current hospital. Written permission was
taken from the original authors to use the questionnaires. In-
ternal consistency of the scales was assessed by Cronbach’s
Alpha coefficient and found to be adequate: 0.882 for Moti-
vation at Work Scale (MAWS), 0.868 for Higher Order Need
Strength Scale, 0.873 for Shared Values Scale, 0.841 for JSS
and 0.908 for the whole scale.
Ethical approval was obtained from the Ethics committee
from the study setting. The study has no harm on the study
sample. The study sample were permitted to withdraw from
the study at any time. In addition, a cover page was cre-
ated and attached to the questionnaire which incorporates an
introduction about the purpose of the study, how and why
the study sample were involved in the study, how long the
questionnaire would take to be completed and the intended
use of the results. Additionally, study sample were assured
about information confidentiality.
2.5 Data analysis
A descriptive analysis was used to analyze the data of this
study using SPSS (Statistical Package for the Social Sci-
ences program) software version 20. Descriptive statistics
were used for all data including frequency distributions and
cross-tabulations. Spearman’s rank correlation calculated for
testing the relationships between continuous variables.
3. RESULTS
3.1 Sociodemographic characteristics of nurses
The results of sociodemographic characteristics of nurses is
presented in Table 1.
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Table 1. Frequency distribution of the registered nurses regarding sociodemographic variables (n = 280)
Sociodemographic Classes of Variables n = 280
N %
Age
Less than 25 years 4 1.4
26-< 35 years 128 45.7
35-< 45 years 84 30.0
45 and above 64 22.9
Gender Male 15 5.4
Female 265 94.6
Marital status
Single 93 33.2
Married 181 64.7
Divorced 4 1.4
Widow 2 0.7
Nationality Saudi 47 16.8
Non-Saudi 233 83.2
Educational level
Diploma 82 29.3
Baccalaureate 170 60.6
Masters 17 6.1
PHD, DNP or other terminal degree 1 0.4
Others 10 3.6
Years of experience
Less than 5 11 3.9
(5-< 10) 78 27.9
(10-<20) 116 41.4
20 and more 75 26.8
Working period at (KFSH& RC, J)
Less than 1 year 5 1.8
1-5 years 114 40.7
6-10 years 73 26.1
11-15 years 61 21.8
16-20 years 25 8.9
21 years or more 2 0.7
Position title or grade Staff Nurse 252 90.0
Grade 9 and above 28 10.0
A total of 280 registered nurses completed the questionnaires.
Less than half of nurses were between 26 -< 35 years of age
(n = 128, 45.7). In regard to the nationality, non-Saudi nurses
were more than three quarters (83.2%). The education level
of the respondents showed that almost two thirds (60.6%)
had baccalaureate degree. More than two thirds (68.2%) of
the respondents had 10 and above years of experience. The
results revealed that less than half (42.5%) of nurses had 1-5
years of employment at the current hospital. Furthermore,
nurses who participated in this study were represented from
different units: critical care units 25.4%, general units 55.4%,
units under ambulatory services 16.9% and other units 2.3%.
The majority of the sample (90%) were staff nurses from
grade 8 while 10% of nurses were nurses mangers from grade
9 and above.
3.2 Work motivation level
The results of work motivation level is presented in Table 2.
Table 2. Nurses work motivation (n = 280)
Motivation Items Weighted Mean SD Motivation level
Total of Intrinsic work motivation 3 4.64 1.10 High
Total of Extrinsic work motivation 9 4.54 0.94 High
Subcategories of
Extrinsic work
motivation
Identified regulation of extrinsic work motivation 3 5.00 1.12 High
Introjected regulation of extrinsic work motivation 3 4.51 1.34 High
External regulation of extrinsic work motivation 3 4.10 1.06 Moderate
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The total weighted mean for extrinsic work motivation (4.54
±
0.94) was lower than intrinsic work motivation (4.64
±
1.10). Nurses’ work motivation level was moderate in ex-
ternal regulation of extrinsic work motivation (4.10
±
1.06)
but high in both intrinsic work motivation (4.64
±
1.10) and
in two subcategories of extrinsic work motivation namely
identified regulation (5
±
1.12) and introjected regulation
(4.51 ±1.34).
3.3 Personal factors
3.3.1 Higher order need strength
The results of work motivation level is presented in Table 3.
Table 3. The weighted means, standard deviations and overall nurses’ responses of higher order need strength
Items of Higher Order Need Strength Weighted Mean SD Overall Response
Using your skills to the maximum. 6.24 1.11 Extremely important
Achieving something that you personally value. 6.11 1.03 Fairly important
The opportunity to make your own decisions. 5.95 1.06 Fairly important
The opportunity to learn new things. 6.25 1.01 Extremely important
Challenging work. 6.08 1.01 Fairly important
Extending your range of abilities. 6.09 1.05 Fairly important
Total 5.67 0.74 Fairly important
The total weighted mean of higher order need strength (5.67
±
0.74) which indicated as “fairly important” need to the
nurses. Moreover, the highest weighted mean reported by
nurses was 6.25
±
1.01 for “the opportunity to learn new
things” followed by 6.24
±
1.11 to the statement “using
skills to the maximum” which both indicated as “extremely
important” needs to nurses. However, the lowest weighted
mean was 5.95
±
1.06 for “the opportunity to make your
own decisions” which indicated “fairly important” need.
3.3.2 Shared values
The results of shared values is presented in Table 4.
Table 4. The weighted means, standard deviations and overall nurses’ responses of shared values
Items of shared values Weighted mean SD Overall response
I share the values and believes of this hospital. 5.56 1.29 Agree moderately
Managers here are understanding about employees having to meet
family responsibilities. 5.33 1.49 Agree moderately
People working here are encouraged to develop themselves. 5.39 1.39 Agree moderately
I am proud to tell people what specialty or profession I’m working in. 5.99 1.26 Agree moderately
I am proud to tell people what institution I’m working at. 6.09 1.18 Agree moderately
Total 5.67 1.08 Agree moderately
The total weighted mean of nurses’ shared value (5.67
±
1.08). Nurses “agreed moderately” to the statement “I am
proud to tell people what institution I’m working at” with
highest weighed mean (6.09
±
1.18). Whereas, the low-
est weighted mean (5.33
±
1.49) was reported by nurses
who “agreed moderately” to the statement “Managers here
are understanding about employees having to meet family
responsibilities”.
3.4 Organizational factors
3.4.1 Sub-factors of job satisfaction survey (JSS)
The results of organizational factors is presented in Table 5.
Nurses ‘agreed moderately’ that supervision and nature of
work can motivate them to work with the total weighted mean
(4.78
±
0.94); (4.53
±
0.85) respectively. Whereas nurses
‘agreed slightly’ that communication and contingent rewards
can motivate them to work with the total weighted mean
(4.28
±
0.91), (3.52
±
0.95). However, nurses ‘disagreed
slightly’ that the pay and promotion can motivate them to
work with a total weighted mean of (3.14
±
0.97), (3.38
±
0.86) respectively. Moreover, nurses ‘disagreed slightly’ that
operating conditions and fringe benefits can motivate nurses
to work with the total weighted mean (2.99
±
0.70), (2.89
±
0.91).
3.4.2 Working conditions
The results of working conditions is illustrated in Table 6.
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Table 5. The weighted means, standard deviations and overall responses of nurses in JSS (n = 280)
Items Mean SD Overall response
Pay
1- I feel I am being paid a fair amount for the work I do. 3.26 1.61 Disagree slightly
10- Raises are too few and far between. 2.86 1.26 Disagree slightly
19- I feel unappreciated by the organization when I think about what they pay me. 3.36 1.47 Disagree slightly
28- I feel satisfied with my chances for salary increases. 3.08 1.75 Disagree slightly
Total 3.14 0.97 Disagree slightly
Promotion
2- There is really too little chance for promotion on my job. 3.04 1.47 Disagree slightly
11- Those who do well on the job stand a fair chance of being promoted. 3.74 1.41 Agree slightly
20- People get ahead as fast here as they do in other places. 3.41 1.25 Disagree slightly
33- I am satisfied with my chances for promotion. 3.34 1.44 Disagree slightly
Total 3.38 0.86 Disagree slightly
Supervision
3- My supervisor is quite competent in doing his/her job. 4.78 1.20 Agree moderately
12- My supervisor is unfair to me. 4.99 1.29 Agree moderately
21- My supervisor shows too little interest in the feelings of subordinates. 4.48 1.41 Agree moderately
30- I like my supervisor. 4.88 1.15 Agree moderately
Total 4.78 0.94 Agree moderately
Fringe
Benefits
4- I am not satisfied with the benefits I receive. 3.08 1.54 Disagree slightly
13- The benefits we receive are as good as most other organizations offer. 2.91 1.43 Disagree slightly
22- The benefit package we have is equitable. 3.18 1.34 Disagree slightly
29- There are benefits we do not have which we should have. 2.38 1.55 Disagree moderately
Total 2.89 0.91 Disagree slightly
Contingent
rewards
5- When I do a good job, I receive the recognition for it that I should receive. 3.90 1.48 Agree slightly
14- I do not feel that the work I do is appreciated. 3.79 1.47 Agree slightly
23- There are few rewards for those who work here. 3.19 1.26 Disagree slightly
32- I don’t feel my efforts are rewarded the way they should be. 3.21 1.40 Disagree slightly
Total 3.52 0.95 Agree slightly
Operating
conditions
6- Many of our rules and procedures make doing a good job difficult. 3.03 1.24 Disagree slightly
15- My efforts to do a good job are seldom blocked by red tape. 3.16 1.35 Disagree slightly
24- I have too much to do at work. 2.87 1.32 Disagree slightly
31- I have too much paperwork and documentation. 2.90 1.54 Disagree slightly
Total 2.99 0.70 Disagree slightly
Coworkers
7- I like the people I work with. 4.85 1.04 Agree moderately
16- I find I have to work harder at my job because of the incompetence of people I work with. 4.13 1.42 Agree slightly
25- I enjoy my coworkers. 4.67 1.15 Agree moderately
34- There is too much fighting at work. 4.11 1.52 Agree slightly
Total 4.44 0.94 Agree moderately
Nature of
work
8- I sometimes feel my job is meaningless. 4.26 1.48 Agree slightly
17- I like doing the things I do at work. 4.71 1.09 Agree moderately
27- I feel a sense of pride in doing my job. 4.74 1.06 Agree moderately
35- My job is enjoyable. 4.40 1.22 Agree moderately
Total 4.53 0.85 Agree moderately
Communi-
cation
9- Communications seem good within this organization. 4.26 1.18 Agree slightly
18- The goals of this organization are not clear to me. 4.79 1.31 Agree moderately
26- I often feel that I do not know what is going on with the organization. 3.78 1.37 Agree slightly
36- Work assignments are not fully explained. 4.27 1.51 Agree slightly
Total 4.28 0.91 Agree slightly
The results of working conditions is illustrated in Table 6.
Half of nurses (52.5%) had overtime in their hospital. In
terms of working for others, half of nurses (55.7%) were
seldom working for their colleagues who are ill or absent
for other reasons in addition to their own work. Regard-
ing participants’ schedule, two third of nurses (61.1%) were
rotating between day and night shifts and almost one third
(28.9%) had fixed schedule (day work with regular working
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hours). In addition, the most three opportunities needed by
nurses were “flexible working hour”, followed by “change
shift with other”, and “plan your working schedule by your
own” respectively 46.4%, 28.9% and 28.6%.
3.5 Correlations between nurses’ work motivation and
(personal & organizational) factors
Correlations between nurses’ work motivation and personal
and organizational factors is found in Table 7.
Table 6. Frequency and relative frequency distribution of the sample according to working conditions variables
Working conditions instrument Classes of Variables n = 280
f %
Do you work overtime in your
hospital?
Yes 147 52.5
No 133 47.5
How often do you have to do the
work of colleagues who are ill or
absent for other reasons in
addition to your own regular
work?
Never 31 11.1
Seldom 156 55.7
Quite often 64 22.9
Very often 18 6.4
Does not apply 11 3.9
What kind of working schedule do
you have in your current position?
Day work with regular working hours (fixed schedule) 81 28.9
Shift work without nights 20 7.1
Rotating day and nights shifts 171 61.1
Only night shifts 4 1.4
Other 4 1.4
Needing any of these
opportunities
1- Flexible working hour 130 46.4
2- Nursery at work-place or the compensation of it 50 17.9
3- Share the workload or shift to some-one else 58 20.7
4- Work at or from home in normal working hours 27 9.6
5- Change your shift with someone else 81 28.9
6- Plan your working schedule on your own (pick suitable date, time etc.) 80 28.6
7- Parental leave 66 23.6
8- None of these 68 24.3
4. DISCUSSION
4.1 Personal factors affecting nurses’ work motivation
The current study demonstrated that the attainment of higher
order needs was positively correlated with IM and all types
of EM. This result is in line with a study which suggested
that attainment of higher order needs increased both IM and
EM level of hospital nurses.
[5]
This can be explained by
the notion that nurses at the current hospital had the need
for achievement, growth and self-actualization (higher order
needs), while the stronger need was for material and social
benefits (lower order need).
In the context of higher order needs, nurses in the current
study highlighted that opportunity to learn new things and
the maximum use of skills were the highest needs. This
result is in agreement with another study suggested that most
motivations common among nurses were satisfied derived
from a sense of accomplishment followed by the desired to
learn new things.
[9]
Nursing and technology advances move
fast. Thus, new nurses require advanced knowledge and
experience at work to be more familiar with new technology.
The results of the present study revealed that shared values
were positively correlated with nurses’ work motivation (with
both IM and EM). This result is supported in the literature
which indicated that shared values is positively associated
with IM and with two types of EM namely identified reg-
ulation and external regulation.
[35, 37]
Nurses at the current
hospital had more shared values with their organization and
therefore were more autonomously and intrinsically moti-
vated. A possible explanation for this is that if the nurses’
values of and their organization are compatible the values
will be internalized. Consequently, nurses will have more
self-direction and their work become more meaningful and
personally important.
4.2 Organisational factors and extrinsic work motiva-
tion
This study found that there is a positive relationship between
promotion and EM (identified regulation and external regu-
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lation). This outcome is corresponding to previous studies
that found the promotion as a predictors of health worker
motivation.
[27, 37–39]
The positive relationship between pro-
motion and EM can be explained by the fact that giving the
opportunity for promotion within the hospital will allow the
nurse to achieve life’s goal through the work involvement
and organizational commitment. Additionally, opportunities
for promotion can give the nurse a sense of value leading
to increase the motivation level. Furthermore, new or high
responsibilities with the new promoted job can fulfils nurses’
career plan. In addition to this, when the nurse is promoted
within the hospital this lead to an increase within the salary
and therefore nurses can be motivated by having an allowance
and have a good standard of living.
Table 7. The correlations between work motivation and personal and organizational factors (n = 280)
Work Motivation
Factors The test Intrinsic work
motivation
Identified
regulation
Introjected
regulation
External
regulation
Personal factors
Higher order need strength Spearman 0.310** 0.294** 0.287** 0.373**
(p-value) .000 .000 .000 .000
Shared values Spearman 0.425** 0.404** 0.395** 0.253**
(p-value) .000 .000 .000 .000
Organizational factors
Pay Spearman 0.218** 0.170** 0.183** 0.192**
(p-value) .000 .004 .002 .001
Promotion Spearman 0.086 0.132* 0.110 0.137*
(p-value) .149 .028 .066 .022
Supervision Spearman 0.197** 0.207** 0.192** 0.055
(p-value) .001 .001 .001 .359
Fringe Benefits Spearman 0.143* 0.124* 0.100 0.048
(p-value) .017 .038 .097 .425
Contingent rewards Spearman 0.221** 0.219** 0.207** 0.105
(p-value) .000 .000 .000 .078
Operating conditions Spearman 0.070 0.010 0.089 0.002
(p-value) .241 .871 .138 .974
Coworkers Spearman 0.205** 0.225** 0.171** 0.042
(p-value) .001 .000 .004 .481
Nature of work Spearman 0.538** 0.400** 0.333** 0.098
(p-value) .000 .000 .000 .103
Communication Spearman 0.174** 0.205** 0.193** 0.070
(p-value) .003 .001 .001 .246
*p < .05; **p < .01
4.3 Organisational factors and intrinsic and extrinsic
work motivation
This study demonstrated that there is a positive relationship
between pay and IM and all types of EM. This finding is
compatible to previous studies suggested that salary increase
is important motivating factor could promote nurses’ work
motivation level.
[20, 22, 24, 28, 30, 40–42]
This can be explained
by the fact that income and financial allowance is impor-
tant motivators which able to fulfil various individual needs.
Moreover, receiving a good salary for all nurses can result in
feeling of enjoyment and pleasure in doing the work.
Regarding the supervision in this hospital, this study demon-
strated that there was a positive relationship between super-
vision and IM and EM. This outcome is corresponding to
previous study which found that supervision is associated
with healthcare workers’ motivation.
[43, 44]
Similarly, super-
visors’ support was found to be important motivating factors
in several studies.
[11, 16, 20]
Supportive supervision can create
a healthy work environment as nurses can feel the sense of
pleasure and fun in their job as well as assist them to meet
their personal values.
Considering the contingent rewards, this study demonstrated
32 ISSN 1925-4040 E-ISSN 1925-4059
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2019, Vol. 9, No. 9
that there is a positive relationship between contingent re-
wards (as recognition, appreciation and rewards) and IM and
EM. Comparing the current result, it was suggested that re-
wards and nurses’ work motivation are directly and positively
associated.
[46]
This finding is consistent with several studies
found contingent rewards as motivating factors which can
increase nurses’ work motivation level.
[20, 26, 28, 42]
The fact
that being recognized and appreciated is a validation of the
nurse competence and therefore this can motivate nurses to
work.
Regarding the co-workers, this study revealed a positive rela-
tionship between co-workers and IM and EM. This finding is
compatible with several studies which found that nurses can
be motivated with their co-workers as effective team work
is considered as important motivating factors in the health-
care organization.
[11, 22, 47]
In addition, functional teamwork
increased intrinsic work motivation only.
[35]
Good relation-
ship between coworkers enhance work to be more fun and fit
nurses’ values. Moreover, high competition between nurses
can motivate them to work hard to avoid failure and blame
and increase their chance to success.
With regards to communication, the current study revealed
a positive relationship between communication and IM and
EM. This finding is consistent with previous studies sug-
gested that supportive relationship in the workplace (be-
tween team members) that valued effective communication
and feedback was found to be linked with an increase of
nurses’ work motivation.
[17, 19, 22, 45]
Similarly, effective com-
munication in the organization increased the health workers
motivation.
[38]
Therefore, effective communication between
team members make the job enjoyable and fun as well as
allow nurses to reach their goals and be a winner which will
increase work motivation level. Additionally, the results that
communication associated with introjected regulation indi-
cates a certain external pressure as there are many nurses who
communicate well not because they have an inner interest,
but rather because they are afraid from failure and losing the
respect of individuals who have placed a lot of expectations
on them.
The current study was conducted in one governmental hospi-
tal in SA, and therefore it is difficult to generalize the results
of the current study as SA is characterized by having differ-
ent healthcare systems and therefore different work contexts.
In addition, finding and selecting appropriate instrument for
measuring all the organizational factors that are related to
nurses’ work motivation was very challenging in designing
this study due to the in-depth search in the database and con-
sultations with several academic staff in this domain. This
was resulted in using two previously used scales were JSS
[36]
and working condition scale.
[35]
Unlike other tools about
work in general, these were considered to describe uniquely
nurses’ common working conditions and work-place features
in the actual context of their professional work.
5. CONCLUSION
This study found that pay is an important factor affecting all
types of nurses’ work motivation. Furthermore, among all
the correlations between work motivation and organizational
factors, the highest correlation was found between nature of
work and each of intrinsic work motivation followed by iden-
tified regulation then introjected regulation of extrinsic work
motivation. However, no correlation was found between op-
erating conditions (including rules and procedure and work
overload) and all types of work motivation. The results of
this study are difficult to be generalized as this study was
conducted in one governmental hospital in SA.
There is a need for enhancing motivation strategies by pro-
viding satisfactory remuneration for nurses as insufficient
amount of payment and allowances would lead to low level
of work motivation. Increase the chances of promotion for
nurses in the current hospital by increasing the number of
the new positions as required such as having nurse educators’
positions within the units that need this service. Encourage
supportive supervision by paying more consideration and in-
terest to the feeling of staff as well as to be fair in treating all
the staff in a similar way within the organization to promote
positive managerial practices and create motivation strate-
gies that focus on justice, positive environment to increase
motivation level among nurses. Increase the chance for the
nurses to have flexible working hours, such as part time op-
portunity to nurses which assist them to achieve better work
life balance and increase work motivation level. Providing
flexible policy that allow nurses to change shift with other
when possible and allow them to plan their working sched-
ule by their own such as pick the appropriate time and date.
Assess nurses’ work motivation level by surveying nurses
frequently. Moreover, a qualitative research is required to
explore how and why personal and organizational factors
affecting nurses’ work motivation by using interviews and
focus groups for more in-depth exploration and explanation
regarding nurses’ work motivation. Furthermore, a further
study is needed to examine the impact of nurses’ motivation
at work and patients’ outcomes.
ACKNOWLEDGEMENTS
Special thanks to my family members in particular my par-
ents, husband and kids for their continuous support and en-
couragement. Also, I would like to offer my sincere thanks
Published by Sciedu Press 33
http://jnep.sciedupress.com Journal of Nursing Education and Practice 2019, Vol. 9, No. 9
and appreciation to M Gagne, P Warr, K Toode and PE Spec-
tor who gave me the permission to conduct my research using
their tools.
CON FLICT S OF INTEREST DISCLOSURE
The authors declare that there is no conflict of interest.
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