relationship between nurse unit managers' motivation and their

21
International Research Journal of Basic and Applied Sciences Vol 4, No. 5;May 2012 34 [email protected] Relationship between Nurse Unit Managers' Motivation and Their Performance Management in Selected Hospital at Makkah Al Moukarramah, KSA and 1 al M. Ibrahim n Ma 2 Sayed . laY a H 1*2 Faculty of Nursing, Umm Al Qura University, Makkah, KSA. 1 Faculty of Nursing, Menofia University. Faculty of Nursing, Cairo University 2 Egypt Abstract Background: Nurse unit managers' motivation is a key factor that might affect the success of an intervention to improve their performance management. Motivation is the key of a successful organization to maintain the continuity of the work in a powerful manner and help organizations to survive. Managers who are motivated to do their work are enthusiastic, responsible, caring, and eager to improve. Aim.The aim of this research is to assess the relationship between nurse unit managers' motivation and their performance management.Design. The research design of the study is a descriptive correlational research design. Setting. The study conducted at King Abdul Aziz hospital, King Faisal hospital and Maternity& Children hospital at MakkahAl Moukarramah. Sample. Convenient sample was used to collect the data. The total sample of this study was 60 nurse' unit managers, 22 from King Abdul Aziz hospital, 20 from King Faisal hospital and18 from Maternity& Children hospital. Tools. There were two tools used to carry out this study.Results. More than half (58.3%) of the study subjects was in age group (30-39). There was highly statistical significant correlation between thenurse unit managers' motivation and their performance management. While, there was highly statistical significant difference was observed between the hospitals regarding to motivation and performance management.Conclusion. This study concluded that, the motivation (drive, control, relationships, challenges, and rewards) in the work environment at governmental hospitals can be effective method to motivate the nurse' unit managers as they affect the way of the

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Page 1: Relationship between nurse unit managers' motivation and their

International Research Journal of Basic and Applied Sciences Vol 4, No. 5;May 2012

34 [email protected]

Relationship between Nurse Unit Managers' Motivation and Their

Performance Management in Selected Hospital at Makkah Al

Moukarramah, KSA

and1

al M. IbrahimnMa2

Sayed.laYaH 1*2

Faculty of Nursing, Umm Al Qura University, Makkah, KSA. 1Faculty of Nursing, Menofia University. Faculty of Nursing, Cairo University

2 Egypt

Abstract Background: Nurse unit managers' motivation is a key factor that might

affect the success of an intervention to improve their performance

management. Motivation is the key of a successful organization to

maintain the continuity of the work in a powerful manner and help

organizations to survive. Managers who are motivated to do their work

are enthusiastic, responsible, caring, and eager to improve. Aim.The aim

of this research is to assess the relationship between nurse unit managers'

motivation and their performance management.Design. The research

design of the study is a descriptive correlational research design. Setting.

The study conducted at King Abdul Aziz hospital, King Faisal hospital

and Maternity& Children hospital at MakkahAl Moukarramah. Sample.

Convenient sample was used to collect the data. The total sample of this

study was 60 nurse' unit managers, 22 from King Abdul Aziz hospital, 20

from King Faisal hospital and18 from Maternity& Children hospital.

Tools. There were two tools used to carry out this study.Results. More

than half (58.3%) of the study subjects was in age group (30-39). There

was highly statistical significant correlation between thenurse unit

managers' motivation and their performance management. While, there

was highly statistical significant difference was observed between the

hospitals regarding to motivation and performance

management.Conclusion. This study concluded that, the motivation

(drive, control, relationships, challenges, and rewards) in the work

environment at governmental hospitals can be effective method to

motivate the nurse' unit managers as they affect the way of the

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35 [email protected]

performance management. Recommendation.Rewards must be

commensurate with the nature of individuals and not with the nature of

the functional cadres, those up can be considered as a good motivational

tool.

Keywords: Nurses' Unit Manager, Motivation, Performance Management.

Introduction:

Motivation is an important factor on which organizational efficiency

depends. It is a process of arousing behavior, sustaining behavior and

channeling behavior in specific course. It explains why some people work

hard and well whereas others perform poorly(Franco et al.2002). In

nursing management, staff needs to be motivated to have quality patient

care, to develop staff efficiency and to reduce absenteeism. A nursing

superintendent must reward the good nursing care given by staff nurse so

that she is motivated to work harder (Dieleman, et al. 2006)(Ibrahim,et

al. 2003).

Performance management is a participative process in which the

staff member and unit manager share responsibility for the development

of an action plan,by participating effectively in the performance

management plan.Staff members have an opportunity to gain personal

recognition and development.Performance management recognizes that

the effective operation of the unit depends on the knowledge, skills and

performance of its staff. It is working in a way that will enable continuous

performance improvement in line with the unit direction, and will at the

same time increase staff innovation and job satisfaction(Boyett et al.

2000).

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The unit managers' duties include providing communication

between the nursing staff, medical staff, administrative staff and any

governing bodies within the organization. The nurse administrators must

be familiar with the specifics of the health care industry and be able to

effectively translate a variety of ideas to others within the organization

that may not be as well versed in the field (Boyett et al. 2000 &Howell,

2000).

An organization needs to influence satisfiers through performance

management the "measuring, monitoring and enhancing the performance

of staff", using a range of human resources management (HRM) tools

such as: job descriptions, supervision, performance appraisals, continuous

education, rewards and career development(Martinez, 2001 & Family

Planning Management Development Technical Unit, 1998).

Nurse managers play a vital role in health care. They are the

essence of any health care system. Their chief responsibilities include

taking care. Their ultimate goal is implementation of policies that ensures

care, compassion and dedicated health care services(Stewart, 2004).

Significance of the study

Motivation can help improve unit managers' performance, reduce the

chances of low manager morale, encourage teamwork and instill a

positive attitude during challenging times. Unit managers' with a high

level of motivation typically work harder and provide high-quality of

care, maintain a high level of productivity and overcome common

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workplace challenges with ease, this helps the unit reach its objectives

and improve operations overall.

Aim of the study

This study aimed to:

Assess the relationship between nurse unit managers' motivation and their

performance management.

• Research Question

What is the relationship between nurse unit managers' motivation and

their performance management?

Subjects and methods

Research Design

The research design of the study is a descriptive correlational design.

Setting

The present study was conducted in three hospitals at Makkah Al

Mokarama, Saudi Arabia. The first setting is the King Abdul-Aziz

hospital. This hospital was built in 1376 AH, located in the AL-Zaher

street; it is considered one of the oldest hospitals in Makkah, composed of

eleven units and wards as follow: renal dialysis, OPD, ER, OR, medical

male, medical female, surgical male, surgical female, orthopedics, ICU

and day care unit.

The second setting is the King Faisal hospital is one of the medical

edifices in the Holy City which provides therapeutic services at all levels.

This hospital was built in 1384 AH. Composed of ten units and wards as

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follow: OPD, ER, OR, ICU, surgical male, surgical female, medical male,

medical female, renal dialysis and viruses & isolation unit.

The third setting is the Maternity& Children hospital which is the first

governmental hospital in KSA for treating the maternity and children

diseases. This hospital was built in 1372 AH. It's in Jarwal region,

composed of four floor with 300 bed capacity and eleven units and wards

as follow: gynecology ER, pediatric ER, OPD, anti natal ward, delivery

room, OR, nursery, surgical ward, post natal ward, pediatric ward and

gynecology ward.

Sample

Convenient sample was used to collect the data. The total sample

of this study was 60 nurse unit managers, 18 from Maternity& Children

hospital, 22 from King Abdul Aziz hospital and 20 from King Faisal

hospital. The unit managers fall into two categories: a bachelor degree in

nursing and a diploma in nursing. The number of bachelor was 14, and

the number of diploma was 46 unit managers.

Tools of data collection

In order to fulfill the research aim, two tools were used to collect

data. First, motivation tool, which was developed by Smith (1988).This

tool aimed at assessing the unit managers’ motivation. The Questionnaire

is consists of 35 items: divided to 5 categories as follow: drive (10 items),

control (6 items), relationships (5 items), challenge (11 items) and

rewards (3 items).

Second, performance management tool, which was developed by

Family Planning Management Development Technical

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Unit(1998).The tool aimed at assessing unit managers' performance

management. It consists of 45 items: divided to 5 categories as follow:

departmental responsibilities (7 items), nursing process / patient care

responsibilities (15 items), continuing education (5 items), equipment (6

items), and attitude (12 items).The tool had translated into Arabic to

make it easier for the diploma nurses who are not fluent in English.

Responses to the questions of two tools were answered by “agree”,

“neutral”, and “disagree”; scored by using a likert scale from1 to 3

respectively.

Statistical Analysis

Data entry and analysis were done using Statistical Package for the

Social Sciences “SPSS” program, version 13. Data were presented using

descriptive statistics in the form of frequencies and percentages for

qualitative variables and means and standard deviations for quantitative

variables. ANOVA analysis was used for assessment of the relationships

of the study variables among three hospitals. Chi-Square analysis was

used for assessment of the relationships among qualitative variables. T-

test was used to test significant. Statistical significance was considered at

p-value ≤ 0.05.

Pilot study

After review of the tools by experts and its approval, a pilot study

was carried out before starting the actual data collection. The purpose of

the pilot study was to ascertain the clarity, and applicability of the study

tools, and to identify the obstacles and problems that may be encountered

during data collection. It also helped to estimate the time needed to fill in

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the questionnaire. Based on the results of the pilot study, modifications,

clarifications, omissions, and rearrangement of some questions were

done. The pilot study was done on 5 assistant head nurses and 5 unit

managers working in different wards/units on King Faisal hospital, King

Abdul- Aziz hospital and Maternity& Children hospital and those were

included in the total study subjects after reassessment and modification of

the tools.

Ethical Considerations and Procedure

Before any attempt to collect data, a formal letter was issued from

the Faculty of Nursing Umm Al Qura University, to obtain an official

approval from the administrators of the hospitals where the data were

collected to conduct the study. The letter identified the researchers, the

title and aim of the research. The data collection phase of the study was

carried out in one month (May 2011). The researcher introduced herself

to the respondents, and explained the aim of the study to the unit

managers in the study setting. Each participant was notified about the

right to refuse to participate in the study before taking her verbal consent.

Anonymity and confidentiality of the information gathered was ensured.

Then, the study tools was distributed to them, during morning shift for

one day/week, with instructions about its filling and collected on the same

day. This was repeated in each unit/ward of the study hospitals. The

researcher was present most of the time to clarify any ambiguity. The

time taken for every questionnaire to be completed was about 30-50

minutes for each nurse unit manager.

Results

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Table (1):Distribution of demographic variables and general

characteristics of the study subjects.

Variables No = 60

Age NO %

20-29 10 16.7

30-39 35 58.3

40-49 10 16.7

50-60 5 8.3

Gender NO %

Male 4 6.7

Female 56 93.3

Marital Status NO %

Unmarried 29 48.3

Married 31 51.7

Level of Education NO %

Diploma 46 76.7

Bachelor 14 23.3

Experience Years NO %

1-10 30 50

11-20 20 33.3

20- 10 16.7

Training Courses NO %

Yes 60 100

No 0 0

Number of training

courses

NO %

1-20 46 76.7

21-40 10 16.6

41- 4 6.7

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Table (1) illustrate that, more than half (58.3%) of the study subjects

were in age group (30-39), while the least frequent (8.3%) of them were

in the age group (50-60). Regarding to the gender of the study subjects,

the highest percentage (93.3%) was female, while the lowest percentage

(6.7%) was male. Nearly half (51.7%) of the study subjects were married,

while unmarried were 48.3%. According to the level of education, more

than three fourths (76.7%) of the study subjects were diploma nurse.

While, the rest (23.3%) of them were bachelor degree. In relation to years

of experience for the study subjects was found that 50% of them had

experience ranging from (1-10) years, while the least percentage (16.7%)

had experience of more than 20 years. Also, 76.6% of the study subjects

had received training courses and hold a number of training courses

ranging between (1-20) , compared to 6.7% of them had training courses

more than 40 courses.

Table (2):Percentage distribution of the total study subjects

according to motivation categories

Motivation Agree Neutral Disagree

No % No % No %

Drive 52 86.7 3 5 5 8.3

Control 56 93.3 3 5 1 1.7

Relationships 51 85 8 13.3 1 1.7

Challenges 55 91.7 5 8.3 0 0

Rewards 46 76.7 4 6.6 10 16.7

Total 86.68 7.64 5.68

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Table (2) showed that, the highest response (93.3%) was observed on

control category, followed by challenges category (91.7%), drive

(86.7%), relationships (85%) and rewards (76.7%). While there was

disagree response regarding to all items except the challenges among the

minority of the study subjects.

Table (3):Percentage distribution of the total study subjects

according to performance management categories

Performance Management Agree Neutral disagree

No % No % No %

Departmental responsibilities 57 95 3 5 0 0.00

Nursing process / Patient. care

responsibilities 57 95 2 3.3 1 1.7

Continuing education 57 95 3 5 0 0.00

Equipment 60 100 0 0.00 0 0.00

Attitude 58 96.7 2 3.3 0 0.00

Totalperformance management 96.34 3.32 0.34

Table (3) illustrated that, the equipment category was more item

supported by (100%) agree response, followed by attitude category

(96.7%). Moreover, the departmental responsibilities, nursing process /

pt. care responsibilities, and continuing education categories were equal

percent (95%). While disagree response was observed regarding to all

items except nursing process / pt. care responsibilities as reported by

1.7% of study subjects.

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Table(4):Relationship between demographic data of the study

subjects and their motivation andperformance management

Motivation

Performance Management

Variables

P F p F

0.80 0.56 0.002** 4.96 Age

0.26 1.30 0.02* 2.96 Years of experience

0.05* 2.12 0.05* 2.53 No. of training courses

*Statistically significant at level ≤ 0.05.

**Statistically significant at level 0.01.

***Statistically significant at level 0.001.

Table (4) clarified that, there was highly statistical significant

relationship between unit managers' age and their performance

management (p = 0.002). Also, there was a statistical significant

relationship between unit managers' years of experience, number of

training courses and their performance management (p = 0.02, 0.05)

respectively. While, there was no statistical significant relationship

between unit managers' motivation and their demographic data except

with number of training courses (p = 0.05).

Table (5):Relationship between demographic data of the study

subjects and their motivation and performance management

Motivation

Performance Management

Variables P 2

χ p 2χ

0.000*** 60.00 0.012** 12.85 Gender

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0.000*** 39.06 0.016** 12.15 Marital Status

0.000*** 42.03 0.000*** 30.47 Level of education

Table (5):illustrated that, there was highly statistical significant

relationship between unit managers' gender, marital status and level of

education and their performance management (p= 0.012, 0.016, and

0.000) respectively. Also, there was highly statistical significant

relationship between unit managers' gender, marital status and level of

education and their motivation (p= 0.000, 0.000, and 0.000)respectively.

Table (6):Relationship between nurse unit managers' performance

management and their motivation

Motivation

Performance Management

p

Drive 22.50 0.000***

Control 36.40 0.000***

Relationship 46.93 0.000***

Challenges 45.66 0.000***

Rewards 10.30 0.006**

Total 29.00 0.000***

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Table (6) clarified that, there was highly statistical significant

relationship between unit managers' performance management and all

categories of their motivation (drive, control, relationships, and

challenge) where p value of chi-square = 0.000, except reward category

where p value = 0.006. Moreover, there was highly statistical significant

relationship between unit managers' performance management and their

total motivation (p = 0.000).

Table (7):Total mean scoresof nurse unit managers' motivation and

their performance management regarding to the hospitals

Variables

King Abdul

Aziz hospital

Maternity&

Children

hospital

King Faisal

hospital

M S.D M S.D M S.D t p

Motivation 42.45 5.15 41.00 4.48 41 4.07 18.90 0.015

Performance

management 45.77 2.24 45.38 2.11 45.85 2.34

29 0.000

Table (7)showed that, the mean and standard deviation was

observed regarding to unit managers' motivation in hospitals as follow:

King Abdul-Aziz hospital (M=42.45, S.D=5.15), Maternity& Children

hospital (M=41.00, S.D=4.48) and King Faisal hospital (M=41.00,

S.D=4.07). Also, the mean and standard deviation were observed

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regarding to unit managers' performance management in hospital as

follow: King Faisal hospital (M=45.85, S.D=2.34), King Abdul Aziz

hospital (M=45.77, S.D=2.24) and Maternity& Children hospital

(M=45.38, S.D=2.11).While, there was highly statistical significant

difference was observed between the hospitals regarding to unit

managers' motivation and their performance management ( 2χ =18.90,

p=0.015) ( 2χ =29, p=0.000) respectively.

Discussion:

The use of positive motivational techniques must be consistent and

timely in order to be effective. Proper use of positive motivation is

critical for nursing managers in today's constantly changing health

environment. Hospitals with effective motivational programs continue to

have the extra edge needed to stayahead of their competitors(Abdel

Hamed, 2002).The aim of the present study was to assess the relationship

between nurse unit managers' motivation and their performance

management.

In the present study, the highest percentage (93.3%) of participants

were female, while the lowest percentage was (6.7%) of them were male,

because the all most of the subjects were female. The present study

findings revealed that, more than half of nurses had diploma, this may be

because nursing diploma program was the only source of nursing

graduate at Makkah Al Mukarama till the recent establishment of faculty

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of nursing at Umm Al Qura University at 2006. The high percentages of

the nurses were married ,because most of them are in age group (30-39).

The finding of the current study,revealed that there was statistical

significant difference between unit managers' number of training courses

and their motivation. This finding is consistent withCapozzoli(1998) who

found that a motivating environment may produce satisfiedemployees,

which in turn may make many employees happy. A motivating

environment exists with conditions of high standards, clear objectives,

adequate training, effective leadership, rewards that employees value, and

adequate working conditions. In the same line,

Kamery(2004) mentioned that one of motivators used by various

organizations include educational trainings programs and staff

development.

Also, Dieleman, etal. (2006) they found that, the main motivators

of health workers were related to responsibility, training and recognition,

next to salary. These can be influenced by performance management (job

descriptions, supervisions, continuous education and performance

appraisal).

All of these represent long-term programs thatare specifically

designed to increase worker satisfaction and effectiveness.So, increasing

number of attending training courses leads to gain new knowledge and

this can lead to gain power and motivation(Bessell, et al. 2006).

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The findings of this study indicated that there was a statistical

significant difference between years of experience and performance

management, this findingis consistent with Peiyulin (2007)who found

that the employees that had been working more than six years

foundinteresting work more important than the employees that had only

beenworking for less than five years. The reason for this could be that

theemployees that had been working for more than six years felt that they

had enough job security, wages that they thought were good enough,

andenough job appreciation from the managers, and were also satisfied

with theworking conditions and loyalty from the company(Hiram, 2003).

In the finding of present study clarified that , there was a highly

statistical significant relationship between gender and motivation. This

finding was supported by Peiyulin (2007)who found that, there were

significant difference between male and female employees regarding

motivation according to whether the wage were good and whether the

manager helped the employees with their personal problems. Majority of

male employees were highly motivated by good wage.

The finding of the current study indicated that, there was a highly

statistical significant difference between rewards and unit managers'

performance management. When rewards are given to those who achieve

high performance, they can become an important instrument to encourage

the continuance of the desired behavior.The relationship between the

employees’ performance and organizationalrewards is

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important(Herzberg, 2003). Managers must make sure that the

employees believe that if theyget a performance appraisal, it will lead to

organizational rewards. Many employees seethis relationship as weak

because the organization does not give rewards just on theirperformance,

so there is a lack of motivation (Robbins, 2003).

The finding of the present study revealed that there was a highly

statistical significant relationship between unit managers' motivation and

their performance management, these finding were supported by

Chowdhury (2007)who found that,unit managers engaged in positive

motivational behaviorsthat managers' intrinsic motivations were

increased, which turn, increased their performance.

Positive Achievement motivational leaders are those whoinspire

followers to transcend their self-interests and whoare capable of having a

profound and extraordinary effecton followers (Robbins, 2003).

Demonstrating positivemotivational behavior becomes instrumental in

motivatingemployee work performance (Mumford et al., 2002;

Robbins, 2003;Chowdhury, 2006& 2004).

Moreover, Motivation is a process of arousing and sustaining

goaldirectedbehaviorof several work motivation theories,both extrinsic

and intrinsic motivation plays an importantrole in influencing employee

work performance(Chowdhury,2007).

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Conclusion:

There was highly statistical significant difference was observed among

the hospitals regarding to motivation and performance management. All

these motivation (drive, control, relationships, challenges, and rewards)

imply that creating a positive environment through encouragement and

positive reinforcement of nurse unit managers will improve work

motivation and performance.

Recommendations:

The present study recommended that:

1- Establishment of training courses and workshops on the importance of

motivate the nurses' unit manager in hospitals to improve and raise

the level of performance management and their skills.

2-Further researches are needed regarding to the factors affect the nurse

unit managers' motivation and their performance management.

3- Administrative directives by the heads of departments must be

participatory, effective and should be moving away from strict orders

to be replaced by the implementation of the action team.

4- The relationship in the workplace should be used well to obtain the

optimum level performance.

Corresponding author

ManalMoussa Ibrahim Moussa

Associate Professor of Nursing Management

Faculty of nursing, Umm Al Qura University, KSA.

Nursing Administration Department, Faculty of Nursing, Menofia

University, Egypt.

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[email protected]

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