MOTIVATION

Motivation is the core of management. Motive is an inner state that energises, activates, or
moves and that directs behaviour towards goals. The success of any organization depends on
the ability of managers to provide a motivating environment for it’s employees. The challenge
for managers today is to keep the staff motivated and performing well in the work place. The
manager has to know the behaviour of each employee and what might motivate each one
individually. By understanding employee’s needs, managers can understand what reward to
use to motivate them.

DEFINITIONS OF MOTIVATION

Motivation refers to the driving and pulling forces which results in persistent behaviour
directed toward particular goal,

“Motivation is the process of arousing the action, sustaining the activity in process and
regarding the pattern of activity”
-Young

“ Motivation refers to the states within a person or animal that drives behaviour towards some
goals”.
-Morgan and King (1975)

CONCEPT OF MOTIVATION
Today virtually all people and scholars have their own concept of motivation and they include
various terms like motives, needs, wants, drives, desires, wishes, incentives, etc. in defining
motivation.
There are 3 items to understand the concept of motivation. ie, motive, motivating and
motivation and their relationship.
1. Motive
A motive is an inner state that energises, activates or moves (hence motivation) and that
directs the behaviour towards goals. A motive is restlessness, a lack , a force which
pull energizes the organism to do something to reduce restlessness, to remedy the lack,
to motivate the force.
Motives are inferences from behaviour (the things that are said and done). They may
be conscious or unconscious. Motives also helps in making predictions about
behaviour.
 Motivating Motivation
Motive

Needs in individuals Activating needs Engagement in action behaviour

and providing needs
satisfaction environment

2. Motivating
Motivating is a term which implies that one person, in the social context, induces
another to engage in action (towards goal) by emerging that a channel to satisfy the
motive becomes available and accessible to the individual.

3.Motivation
While a motive is energizer of action, motivating is the channelization and
activation of motives . Motivation is the action behaviour itself. Motivation depends on
motives and motivating. Therefore, becomes a complex process

The Need-Want Satisfaction Chain

Motivation involves a chain reaction starting out with felt needs resulting in wants or
goals sought which give rise to tension (ie, unfulfilled desires) then causing action towards
satisfying wants .However in reality this chain is more complex that it looks .

Need gives rise to Want cause Tension

gives rise
Action Satisfaction

Motivation is the drive and effort to satisfy a want goal . Satisfaction refers to the
contentment experienced when a want is satisfied. Therefore, a motivation results in
satisfaction .
 NEED FOR MOTIVATION
The nurse manager must realize that nurses have different personalities, work habits ,and
what motivates one may not motivate others. Meanwhile some nurses are skilled ,confident
and capable of self-direction and seem to motivate themselves ,while other nurses lacks
self-confidence ,they do their jobs poorly and have little motivation. The nurse’s manager
is responsible to motivate the second group and improve their performance.
Researchers have revealed that job performance is the result of the interaction of
two variables, the ability to perform the task and the amount of motivation.

Job performance=Ability + Motivation

NATURE OF MOTIVATION
Based on the definition of motivation, we can drive its nature relevant for human
behaviour in organisation. Following characteristics of motivation clarify its nature .
1. Based on motives
Motivation is based on individuals motives which are internal to the individual. These
motives are in the form of feelings that the individual lacks something . In order to
overcome these feelings of lackness, he tries to behave in a manner which helps in
overcoming this feeling.
2. Affected by motivating
Motivation is affected by way the individual is motivated . The act of motivating
channelises need satisfaction.
3. Goal directed behaviour
Motivation leads to goal directed behaviour. A goa directed behaviour is one
which satisfies the causes for which behaviour takes place.
4. Related to satisfaction
Motivation is related to satisfaction. Satisfaction refers to the contentment
experiences of an individual which he drives out of need fulfilment. Thus satisfaction
is consequence of rewards and punishments associated with past experiences.
5. Person motivated in totality
A person is motivated in totality and not in part. Each individual in the
organization is a self contained unit and his needs are interrelated. These affect his
behaviour in different ways. Moreover, feeling of needs and their satisfaction is a
continuous process.

MOTIVATION PROCESS
Motivation process has three components: direction efforts and persistence. It starts
from the arousal of need that leads to creation of tension. This tension also creates drives and
attitudes regarding the type of satisfaction that is desired. This leads a person to venture into
the search of information. This ultimately leads to evaluation of alternatives where the best
alternative is chosen. After choosing the alternative, an action is taken. Because of the
performance of the activity satisfaction is achieved which then relieves the tension in individual
and start with the new need as shown: -
TYPES OF MOTIVATION

There are mainly two types of motivation as per its origin; extrinsic and intrinsic. There are
also other types of motivation as given below:
▪ Extrinsic Motivation
This is a type of motivation that is received from external environment. It has to do with the
incentives. It comes from outside of the performer. Money, popularity, grading, trophies,
competition but coercion, threat from punishment is common examples extrinsic motivation.
▪ Intrinsic Motivation
This is the actual self-motivation; it originates from heart of the person. It is the inner
gratification and feeling of fulfilment, rather than just achieving a goal. Two important
motivating factors are recognition and responsibility. Recognition means being appreciated,
being treated with respect and dignity, feeling a sense of belongingness. Responsibility gives
a person a feeling of belonging and ownership.
Other types of motivation are
• Affiliation Motivation
This type of motivation is a drive that relate to staff on a social basis. This is a strong desire to
associate with different types employees in social matters. The employees are complimented
for their favourable attitudes and cooperation.
• Competence Motivation
Competence motivation allows the staff to perform high quality work. The staff is motivated
to solve the problems and strive to be skilful and creative. They learn from their experiences.
• Achievement Motivation
In this type of motivation, the staff is concerned for more and more achievements and
accomplishment. She wishes to achieve objectives and climb up on the ladder of success.
• Fear Motivation
The staff gets motivated by known or unknown fear and act contrary to her original
intension. It is good to accomplish the work quickly but for short time not always.
 • Incentive Motivation
This is the motivation that arises due to incentives, rewards to do the particular work.
In some instances, the nurses put an extra effort if awarded or gets the incentives in the form
of money etc. This is a type of extrinsic motivation.
• Attitude Motivation
It signifies the way the nurses perceive the future and their reaction regarding the past
occurrences. It reveals the self confidence among nurses. Nurses should have the
positive attitude towards the work, then they will be motivated to do the work.
• Power Motivation
Power motivation is a very strong drive to influence, the nurses and to bring out the
changes in the organization.

MOTIVATION AND PERFORMANCE

Work performance depends on the level of motivation which stimulates them to
come to work regularly, work diligently, and be flexible and willing to carry out necessary
tasks. The performance and quality of health system depends on the quality and motivation of
health human resources. Therefore, nurses’ motivation is likely to have effect on the delivery
of health services the outcome of care and performance of work. Low motivation and poor job
satisfaction has negative impact on health sector, harmfully affecting the job performance as
well as quality of patient care

FACTORS THAT INFLUENCE NURSE MOTIVATION

The 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 nursing organizational success. Managerial planning in a health care facility
involves a deep understanding of motivational drives in turn involves a deep study of the factors
influencing these drives. It is important the “definite causes” based on operational needs in an
analytical fashion. These factors are :-
➢ Hygiene and Motivational Factors:
Hertzberg (1959) recognizes two separate sets of factors that influence motivation
of the workers in an organization normally the hygiene factors and motivational factors.
Hygiene factors are those factors whose presence need not motivate, but whose absence
will demotivate. He also called them maintenance factors or dissatisfiers. Hygiene
factors include organisational policy and administration, and technical supervision, pay,
relationship with the superiors, relationship with subordinates, relationship with peers,
job security, personal life, status and working conditions. Motivational factors are also
known as satisfiers which motivate. They are work itself, achievements, recognition,
advancement, growth and responsibility .
➢ Valence Expectancy and Instrumentality
Vroom (Fred Luthens,2005) views motivation as product of these factors namely,
valence which denotes how much one wants a reward, expectancy, which is nothing
 but an employee’s estimate of the probability that efforts will result in successful
performance and instrumentality, which defines an employee’s estimate that
performance will result in receiving the reward. Thus, it is important for health care
organisation to motivate their nurses by recognising the rewards, the nurses value the
most and not on the rewards the managements offer.
➢ Self Esteem, Job Enrichment
Self-esteem at organisational level breeds a population of motivated individuals
with organisational commitments. Nurses who have managers who can communicate
to them their trust worthy status and value in the organisation will have high levels of
self-esteem.
➢ Attribution
Attribution is another factor by which nurses interpret and assign causes for their
own and other’s behaviours in an organisation. There are two types of attributions
namely; dispositional attribution, that describes a nurses behaviour to internal factors
such as personality traits , motivation or ability and situational attribution that describes
a nurse’s behaviour to external factors such as equipments, work environment or social
influence . Successful management in all about breeding a population of nurses who
attribute their behaviour to internal rather than external factors.
CAUSES OF DE-MOTIVATION
Following are the causes of de-motivation for nurses at their work places :
➢ Work place hazards
There are many risks in healthcare that have the potential to cause serious injury.
One of the most common risk healthcare professionals, including nurses may encounter
sharp injuries. Some of these injuries can expose nurses to blood bone infections that
were potentially life threatening, such as Human Immunodeficiency Virus (HIV)
Hepatitis B virus (HBV)and Hepatitis C Viruses (HCS).
➢ Shift duty pattern and long working hours
Work patterns of long working hours can also affect nurse’s social lie. As nurses
often have less time to be spent with loved ones. This can lead to impaired relationships,
lack of quality interaction with friends and family also increases the risk of isolation
and loneliness. Shift workers may also experience difficulty in assessing adequate child
care services and care. Long working hours has effect on family and social life of the
nurses.
➢ Night Duty
On average, shift staff gets two to four hours less than the recommended eight
hours of sleep in twenty-four hours. The human body normally follows a 24 hour cycle
called the circadian rhythm. This cycle regulates sleeping, waking, digestion, secretion
of adrenalin, body temperature , pulse , and many other important aspects of body
function. If a person alters his or her activity pattern, these rhythms can go out of sync,
leading to disorientation and feeling a fatigue. Nurses need to increase awareness of
shift works effect on performance and patient safety.
 ➢ Shortage and turnover
Shortage and turnover may lower quality and productivity of nursing care, due to
loss of work group efficiency and organisational performance.
➢ Feeling of underpaid
This is another factor for demotivation among nurses. Though the government has
increased pay structure of the nurses which is very important for the nurses to retain in
the hospitals.
➢ Lack of recognition and appreciation
Many people think that nursing degree is not as respected as a medical profession,
though they take care of patience and do a fairly a large amount of work. So lack of
appreciation can have a negative effect in stress and job satisfaction of the nurses and
could adversely influence staff turnover.

THEORIES OF MOTIVATION
Motivation to work is very complex. There are many internal and environmental
variables that affect the motivation to work. Behavioural scientists started to search new facets
of and techniques for motivation. these theories are known as theories of motivation.
1. Maslow’s need hierarchy theory of motivation
Abraham Maslow suggests that human needs are ordered in a hierarchy from
simple to complex. The simplest needs, physiologic needs are the greatest behaviour
motivators until satisfied to the degree needed for sustaining life. Security or safety
needs become predominant once physiologic needs are met. After these two, lower
level needs are fairly well satisfied, affiliation or acceptance will emerge as dominant.
When affiliation needs , a person strives for meaningful social relationships. Next, the
person experiences the need for esteem, both self esteem and recognition from others.
Satisfaction of these needs produces such feelings as self confidence, prestige, power
and control. The final need in this hierarchy is the need for self actualization- the need
to maximise one’s potential. In our society, individuals to seek the higher level needs.
 2. Herzberg’s two factor theory
Herzberg developed a theory of motivation on the premise that human nature has
two separate elements the motivators and the maintenance factors. According to this theory of
motivation, the items that determine job content are considered motivational factors e.g.
achievement, recognition, responsibility, advancement and the work itself. The elements that
influence the job context are the hygiene or maintenance factors. eg company policy, salary,
inter-personal relations, working conditions etc. They must be adequate and if they are absent
or inadequate, they will create dissatisfaction.

1. Hygiene Factors:
Hygiene factors represent the need to avoid pain in the environment. They are not
an intrinsic part of a job, but they are related to the conditions under which a job is
performed. They are associated with negative feelings. They must be viewed as
preventive measures that remove sources of dissatisfaction from the environment.
Herzberg believed that hygiene factors create a zero level of motivation and if
maintained at proper level, prevent negative type of motivation from occurring.
Thus, hygiene factors, when absent, increase dissatisfaction with the job. When
present, they help in preventing dissatisfaction but do not increase satisfaction or
motivation.
2. Motivators:
Motivators are associated with positive feelings of about the job. They make
people satisfied with their jobs. Motivators necessary to keep job satisfaction and job
performance high. Motivational factors or satisfiers are directly related to job content
itself, the individual's performance of it, its responsibilities and the growth and
recognition obtained from it. Motivators are intrinsic to the job.
Thus, when motivators are absent, it prevents both satisfaction and motivation When,
motivators are present, they lead to satisfaction and motivation. To apply the two-factor theory
to the workplace, Herzberg suggests a two-step process.
(a) The supervisor should attempt to eliminate the hygiene factors that are found to be more
basic than factors that lead to satisfaction.
(b) Once the dissatisfiers have been somewhat neutralised, the supervisor may be able to
motivate workers through the introduction of motivational factors

3. Victor Vroom's Expectancy Theory

Victor Vroom (1964), another motivational theorist in the human relations era, developed
an expectancy model, which looks at motivation in terms of the person's valence, or preferences
based on social values. In contrast to operant conditioning, which focuses on observable
behaviours, the expectancy model says that a person's expectations about his or her
environment or certain event will influence behaviour. In other words, people look at all actions
as having a cause and effect, the effect may be immediate or delayed, but a reward inherent in
the behaviour exists to motivate risk taking.
In Vroom's expectancy model, people make conscious decisions in anticipation of reward; in
operant conditioning, people react in a stimulus-response mode. Managers using the
expectancy model must become personally involved with their employees to understand better
the employees' values, reward systems, strengths, and willingness to take risks.

4. McClelland’s needs theory

David McClelland (1971) examined what motives guide a person to action, stating
that people are motivated by three basic needs: achievement, affiliation, and power.
Achievement-oriented people actively focus on improving what is: they transform ideas into
action, judiciously and wisely, taking risks when necessary. In contrast, affiliation-oriented
people focus their energies on families and friends; their overt productivity is less because they
view their contribution to society in a different light from those who are achievement oriented.
Research shows that women generally have greater affiliation needs than men and that nurses
generally have high affiliation needs. Power-oriented people are motivated by the power that
can be gained as a result of specific action. They want to command attention, get recognition
and control others. Mc Clelland theorizes that managers can identify achievement, affiliation
or power needs of their employees and develop appropriate motivational strategies to meet
those needs.

5. McGregor’s theory X and theory Y

Douglas McGregor (1960) examined the importance of a manager's assumptions about
work- ers on the intrinsic motivation of the workers. He examined individuals behaviour at
work. From this he formulated two models of management based on hierarchy into lower-order
needs (Theory X) and higher-order needs (Theory Y). These theories are based on human
behaviour in management. It concludes dual aspects of human being. He suggested that
management could use either set of needs to motivate

Theory X
Theory X assumes that employees are naturally unmotivated and dislike working, and this
encourages an authoritarian style of management. According to this view, management must
actively intervene to get things done. It summaries that workers need to be constantly watched
and instructed what to do.
Theory Y
The assumption that employees like work are creative, seek responsibility and can exercise self
direction.. It further assumes that people welcome opportunities to make contributions and can
be self-directed, creative, and are motivated by exposure to progressively less external control
and progressively more self-control.
6. ERG (Existence, Relatedness, and Growth) Theory

ERG theory, developed by Clayton Alderfer, is a modification of Maslow's hierarchy of needs.

Instead of the five needs that are hierarchically organized; Alderfer proposed that basic human
needs may be grouped under three categories, Existence. Relatedness, and Growth. The
theory's name is based on the first letter of each need.
Existence
Existence refers to basic material existence motivators. Physio- logical and safety needs such
as hunger, thirst and safe condition are the examples of existence.
Relatedness
Relatedness refers to the motivation for maintaining interpersonal relationships. Social and
external esteem needs such as involvement with family, friends, co-workers and employers are
the example of this concern.
Growth
It refers to an intrinsic desire for personal development. Internal esteem and self-actualization
need such as the desire to be creative, productive and to complete meaningful tasks are related
to growth.
The implication of this theory is that we need to recognize the multiple needs that
may be driving nurses at a given point to understand their behaviour and properly motivate
them.
7. Skinner’s positive reinforcement theory
Oparant conditioning or behaviour modification are other names for Skinner’s positive
reinforcement theory. Behaviour may be strengthened or weakened depending on what
follows it. With holding positive reinforcers weakens behaviour, whereas intermittent
 reinforcement increases resistance to extinction. Punishment will help reduce behaviour,
but it cannot teach new behaviours and it may condition avoidance.
Accentuating the positive with plenty of praise and positive feedback may increase the
frequency of desired behaviour. If a subordinate admits to less than desirable behaviour,
the manager may respond, ‘I appreciate your honesty’, while remanding the worker of the
goal. When desired results are not obtained, managers should analyse the situation. First
they should assess the working environment for interference. Does the employee have
adequate time to complete this complete task? Does the system allow nurses to maximise
their efficiency? Or must they spend most of their time running to central supply to gather
materials that should have been readily available?. If managers do not locate the cause of
the problem in the environment, they must ask themselves if the employee has been
properly utilized. Do they have the knowledge and skills necessary to do the job? If not,
can they be taught? If they cannot be taught, can they be replaced and assigned their duties.

MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE NURSES

MOTIVATION
The nurse manager while managing the nursing unit will have to choose a combination of the
following measures to facilitate nurses' motivation.
➢ Set high standards in the units.
➢ Maintain a positive attitude towards the work and staff.
➢ Be optimistic; in other words, be aware of how difficult the job is and how it can be
done.
➢ Ask for help when in need.
➢ Admit mistakes.
➢ Develop and maintain Good Personal Relations
➢ Use two-way communication.
➢ Be friendly, not to criticize staff in front of others and be fair
➢ Keep a sense of humour and avoid getting angry.
➢ Try to understand nurses' attitudes, likes, dislike their experience, previous training,
problems in their work and needs.
These measures will help in understanding nurses' behavior. Understanding is the first step
toward motivating nurses. Trust comes with understanding and it develops slowly based on the
respect and acceptance of the manager. Motivation is based on understanding and trust.
• Some Guidelines for Developing Trust
-Apply rules equally and consistently.
-Avoid favouring some nurses over others, be fair.
-Share information - show respect for ideas and opinions and confidentiality.
-Be supportive at all times.
• Post each nurse where she can work best
The nurse is more likely to succeed and be motivated if her/his interests and skills
are considered in the assignment. Success is the best motivator.
 • Use a Participative Style
Participation and sharing information will motivate nurses since they feel they are taking part
in decisions. Motivation requires more than physical involvement in a job It also demands
mental and emotional involvement.
• Guide, Encourage and Support Continuously
Guidance means helping nurses in planning, evaluating their work and in solving work
and personal problems. Consider individual differences, be sensitive to variations in nurses'
needs, abilities and goals, and provide realistic job information, clear instructions and feedback.
Encouragement means helping and reassuring nurses regardless of the type of problems.
Develop a supportive environment by reducing physical stresses associated with the job.
Encourage nurses to make decisions. Encourage skilled nurses to share their expertise with less
experienced nurses so that both of them are motivated to continue their role.
Support means removing obstructions and providing nurses with satisfying work
environment which include personnel and facilities and suitable learning materials needed to
do their job. Also, improving job content to include more planning and self-direction.
• Reward Good Work
Give recognition for successful achievement of the job. Praise frequently and
informally It can be in front of other staff. Reward includes: Pay increase, promotion, training
for advancement to a higher level within a job. Thank you is a type of reward that helps to
increase self-confidence. Build team work (Team spirit)
• Schedule Regular Meetings
-Make nurses feel that their job is important to the success of the team.
-Integrate the needs and wants of the staff nurses with those of the nursing unit.
-Think of nurses in the unit as a group and do what is best for them.

• Provide Continuing Education

Nurses enjoy learning new knowledge and skills or updating the existing knowledge
and skills or taking new responsibilities through continuing education.

MOTIVATIONAL QUALITIES OF NURSE LEADER

1. Knowledge and skill:

Effective communication of ideas, confidence, commitment, energy, insight into the
needs of others and an ability to take the action necessary to achieve goals important to
others.

2. Responsibility:
Knowledge and skill comes from preparation in the responsibilities of healthcare
delivery and organizational duty. This leader has the ability to evaluate the likelihood of
success in accomplishing goals, and is able to support or suggest changes.
3. Effective communication of ideas:
It involves the ability to convey ideas clearly and in such a way that they can be
heard positively.
 4. Confidence:
It comes from an internal sense of security that one is competent to make a statement
or take action, and that there is a reasonable chance of success in accomplishing
something of value. The motivational leader is secure enough to have a lower need to
control and as a result is able to encourage autonomy, participation and the
empowerment of staff in decision-making.

5. Commitment:
It is the internalization of an idea and a resulting drive to accomplish specific goals.
The mere setting of goals does not indicate leadership that motivates. It is the ability of
the leader to translate the importance of the goal (or purpose) to others and to elicit
actions from others that support reaching a goal.

6. Energy:
It is also needed to empower and fire the imagination of others and constantly
invent and move ahead toward future events as well as current needs. Different styles
of energy can be motivational. The 'high energy leader who is effective in one situation
may be viewed as 'pushy and aggressive' in another situation.

7. Insight into the needs of others:

It is the acute awareness of the reason behind events and an ability to anticipate
results of actions. When a leader can put goals into a form that has real or personal
value to each person, then motivation will exist.

8. Additional key qualities of a motivational leader:

Are abilities to listen, reserve judgment, give direct and positive feed- back,
recognize individual value through respect for others, and use humour. Professional
practice and shared governance depend on the clinical leader to produce an environment
that fosters autonomy in decision-making and provides the skills resources and
information needed for others to make this transition.

SEVEN RULES OF MOTIVATION

1. Set a major goal, but follows a path:

The path has mini goals that go in many directions. When you learn to succeed at
mini goals, you will be motivated to challenge grand goals.

2. Finish what you start

A half-finished project is of no use to anyone. Quitting is a habit. Develop the
habit of finishing self-motivated projects.

3. Socialize with others of similar interest:

Mutual support is motivating. We will develop the attitudes of the five best
friends. If they are losers, we will be a loser. If they are winners.
 4. Learn how to learn:
Dependency on others for knowledge supports the habit of procrastination. Man has
the ability to learn without instructors. In fact, when we learn the art of self-education
we will find, if not create, opportunity to find success beyond our wildest dreams.

5. Harmonize natural talents with interest that motivates:

Natural talent creates motivation, motivation creates persistence and persistence
gets the job done.
6. Increase knowledge of subjects that in- spires:
The more we know about a subject, the more we want to learn about it. A self-
propelled upward spiral develops.
7. Take risk:
Failure and bouncing back are elements of motivation. Failure is a learning tool. No
one has ever succeeded at anything worthwhile without a string of failures.

REQUIREMENTS OF A SOUND MOTIVATION SYSTEM

It is very difficult for an average manager to sort through all the different motivation: theories
and models and know when and how to maximise their application in wide differing situations.
There should be a sound system of motivation to make the workers put forth their best efforts.
A sound system of motivation should have the following essential features.

✓ A sound motivation system should satisfy the needs and objectives of both the
organisation and the employees.
✓ Motivational system should change with the changes in the situation.
✓ Jobs should be designed in such a way as to provide challenge and variety.
✓ Managers should recruit the active co-operation of subordinates in improving the
organisation's output. Subordinates should be made to realise that they are stakeholders
in the organisation.
✓ The motivational system should satisfy the different needs of employees. It should be
directly related to the efforts of the employers.
✓ The motivational system should be simple so that it is easily understood by the workers.

RESEARCH STUDIES RELATED TO MOTIVATION

Motivation and job satisfaction among medical and nursing staff in a Cyprus public general
hospital

Lambrou, P., Kontodimopoulos, N. & Niakas, D. Motivation and job satisfaction among
medical and nursing staff in a Cyprus public general hospital. Hum Resour Health 8, 26 (2010).
https://doi.org/10.1186/1478-4491-8-26
Background
The objective of this study was to investigate how medical and nursing staff of the Nicosia
General Hospital is affected by specific motivation factors, and the association between job
satisfaction and motivation. Furthermore, to determine the motivational drive of socio-
demographic and job related factors in terms of improving work performance.

Methods
A previously developed and validated instrument addressing four work-related motivators (job
attributes, remuneration, co-workers and achievements) was used. Two categories of health
care professionals, medical doctors and dentists (N = 67) and nurses (N = 219) participated and
motivation and job satisfaction was compared across socio-demographic and occupational
variables.

Results
The survey revealed that achievements was ranked first among the four main motivators,
followed by remuneration, co-workers and job attributes. The factor remuneration revealed
statistically significant differences according to gender, and hospital sector, with female
doctors and nurses and accident and emergency (A+E) outpatient doctors reporting greater
mean scores (p < 0.005). The medical staff showed statistically significantly lower job
satisfaction compared to the nursing staff. Surgical sector nurses and those >55 years of age
reported higher job satisfaction when compared to the other groups.

Conclusions
The results are in agreement with the literature which focuses attention to management
approaches employing both monetary and non-monetary incentives to motivate health care
professionals. Health care professionals tend to be motivated more by intrinsic factors,
implying that this should be a target for effective employee motivation. Strategies based on the
survey's results to enhance employee motivation are suggested.