Introduction of the Study
Background of the Study
The Qassim is one of the administrative regions in Saudi Arabia, with a population of approximately 1,370,727 people, suggesting a need for making certain that the healthcare facilities in the area are capable of delivering medical services to these individuals (Central Department of Statistics and Information, n.d.). There are 20 hospitals in the region, with a bed capacity of 50 to 500 each, employing a large number of nurses, physicians, and surgeons.
Inevitably, the management of these entities requires an understanding of factors that affect the work of healthcare professionals, as the overall objective of operations declared by the Ministry of Health (n.d.) is to “transform healthcare delivery to a consistent, world-class standard” (para. 5). Since hospital personnel is the core aspect of quality, it is necessary to examine their work and identify areas of improvement, which in the case of this research, the focus is on motivation.
The nursing workforce globally is responsible for a wide variety of tasks, including attending to the patient’s needs, administering tests and medications, aiding with procedures, and promoting healthy practices and lifestyle changes that will improve a person’s health. According to the Saudi Nursing Society (2016), one of the objectives of nurses’ work is to ensure the adoption of a culture of excellence and respond to challenges within the healthcare environment.
This culture of excellence can be achieved if the conditions and opportunities provided to nurses align with their vision of career and future. Additionally, the number of nurses working in the Kingdom of Saudi Arabia continuously increases since the patient-nurse ratio has increased from 4.8 nurses per 1,000 patients to 5.7 in 2018 (“Kingdom of Saudi Arabia healthcare overview,” 2018). Although this is a positive change, several aspects must be considered, including the average patient-nurse ratio in other states and the fact the number of physicians per 1,000 patients is 2.2., suggesting that nurses have to perform many tasks as part of their day to day job.
In other developed countries, this ratio is above 9, suggesting that the Qassim hospitals will have to undergo a significant transformation in the context of their hiring and management practices (“Nurses (per 1,000 people) – Health nutrition and population statistics,” n.d.). Therefore, the nursing workforce in Saudi Arabia, and Qassim, in particular, exceeds the number of other healthcare professionals, which implies a need to examine the leadership practices used to manage this population adequately. The motivation of nurses for work may vary and include financial incentives, desire to help others, or other extrinsic and intrinsic factors. For adequate management, it is essential to understand what underlying motivation of nurses in the Qassim region.
Nurse motivation has been studied globally by scholars and practitioners because they believe that the link between motivation and work satisfaction exists. Similar studies were conducted in the United States, Europe, and Asia, with the findings suggesting that there are many similarities in nurse motivation (Toode, Routasalo, Helminen, & Suominen, 2015). However, some regional differences exist as well that need to be addressed to develop a comprehensive strategy for addressing nurse motivation for professionals working in the Qassim region.
Aim and Objectives
This research aims to develop a questionnaire that can be used to assess motivation factors that are region-specific and address the work environment of nurses from Qassim.
Hypothesis
This study hypothesizes that nurses in the Qassim region rely mostly on intrinsic motivation, such as the ability to help others, professional growth, career opportunities. As such, leaders of healthcare establishments in Qassim can develop policies and practices that will allow healthcare facilities to enhance nurse motivation and by achieving this, positively impact the work satisfaction, retention, and burnout rates.
Significance of the Study
This research helps address an essential element of healthcare management – the motivation of employees. The cultural and economic environment of the Qassim region and Saudi Arabia, in general, differs from that in Europe, United States, Asia, and other regions, suggesting that the approaches, which healthcare organizations in these regions use can be not as effective when used in Qassim.
However, the motivation of nurses is a global concern because it affects patient outcome all over the world. By researching Qassim will not only help find specific approaches that are most effective for the region but also discover patterns that could be generalized to other geographical locations as well. Therefore, it can be said that the area of nursing practice and nursing management will benefit from the knowledge acquired by the proposed study. The scope of the study is the nurse motivation of professionals working in Qassim, while the limitations include a limited number of participants.
Definition of Terms
The following are the terms that encompass the essential elements that this research will examine. Since motivation is a complicated matter that incorporates external and internal factors, and it affects the desire of a person to stay in the position or change occupation as well as performance, all of the following components will be examined in this research.
- Motivation is a single reason or a set of factors that determine a person’s behavior (Ryan & Deci, 2017).
- Intrinsic motivation relates to the internal factors that serve as a motivation for an individual (Hennessey, Moran, Altringer, & Amabile, 2015).
- The nurse turnover ratio is a percentage of nurses that left their positions divided by the existing staff, which serves as an essential indicator of organizational efficiency and motivation for work (Wang, Liu, & Wang, 2015).
- Burnout – is a psychological condition caused by prolonged stress at work, which affects both performance and motivation, and can lead to high dissatisfaction and turnover rates (Wang, Liu, & Wang, 2015).
- Motivation factors – all the elements that a nurse considers relevant for his or her work (Wang, Liu, & Wang, 2015).
- Nurse work satisfaction – a feeling of wellbeing as a result of interaction with a healthcare organization and one of the elements that can impact motivation (Wang, Liu, & Wang, 2015).
Literature Review and Framework
Framework
The theoretical framework that this research leverages is the relationship between nurse motivation and work outcomes. Firstly, the objective of this study is motivation, therefore the theoretical framework includes some principle theories of motivation and its impact on nurse’s behavior. The general theory suggests two primary domains of motivation – intrinsic and extrinsic or internal and external. Poor work conditions, long hours, workload, lack of organizational support, and guidance are all extrinsic factors that can lead to demotivation and loss of productivity as a result.
Secondly, the relationship between motivation and nurses’ work performance is another essential element of this study. Bodur and Infal (2015) that motivation predetermines a person’s performance and affects a desire to obtain a different job, which is especially relevant in the context of nursing, where the work environment is stressful, patient cases can be complicated, and organizational issues such as staff shortage or prolonged working hours are common. Therefore, this research relies on the theoretical implication that through positive reinforcement of motivation, healthcare managers and leaders can address the existing organizational issues and improve both work satisfaction rates and quality of care.
Related Studies
In this paragraph, similar researches that focus on nurse motivation and the impact of this factor on work outcomes are reviewed. Baljoon, Banjar, and Banakhar (2018) examine the relationship between nurse motivation and elements such as turnover, work satisfaction, and burnout, which are organizational factors that can be affected by management. The authors distinguish two significant categories of nurse motivation – personal characteristics, which include age, education, experience, and other elements, and organizational factors, such as empowerment, financial incentives, and other rewards. The latter is a category that can be influenced by healthcare organizations.
Intrinsic factors of motivation are essential for nurses as the basis of their work is connected to compassion and helping others. Similar findings were reported by Bodur and Infal (2015) and Negarandeh, Dehghan-Nayeri, Ghasemi (2015), who also use these two distinct categories in their study. The latter study argues that opportunities for career development are essential for nurses and can serve as a significant motivation through their work.
The previous study emphasizes the impact of self-concept, which is a perception of self and goal setting, was essential. While in general, the two are intrinsic factors, it can be argued that a healthcare entity can affect these elements by enhancing organizational support and providing more opportunities for personal and professional development.
Some of the studies that examine the specifics of nurses’ work in Saudi Arabia can provide a better understanding of the social and cultural context related to motivation. A study by Al-Tackroni, l-Hindi, Joshva, and Al-Harbi (2016) is one of not many, which focuses on the Qassim region and highlights the average level of work satisfaction. Notably, in this study, the workload is the primary factor causing dissatisfaction among the staff. This study helps understand the problem in the management of the hospitals in Saudi Arabia since little attention is dedicated to determining which elements of work serve as a demotivation for nurses.
Quality of care, as was mentioned, is the primary focus and the basis of the development strategy for the hospitals in Saudi Arabia and Qassim in particular. The study by Al Mutaire (2015) bridges the gap between understanding the quality of care and nurse motivation because the author highlights issues such as “the absence of positive organizational climate and culture, no clear mission, vision, values and policies” (p. 3).
The author concludes that a positive organizational climate, which also aligns with the needs and goals of nurses, can increase their motivation for work. This study implies that nurses’ motivation can be impacted by the appropriate organizational culture, more specifically through such elements as mission, vision, and strategy that correlate with the beliefs of a nurse. The main critique of this article is the fact that it lacks a focus on nurse motivation instead of examining a wide range of factors relating to the quality of care.
Another aspect of nurses’ motivation is the work of management. Alharbi and Alhosis (2019) also provide evidence suggesting that the hospital’s management policy affects the intrinsic and extrinsic motivation of nurses and the authors state that “administrative policies intended to improve the quality of the clinical environment have a great effect on staff retention, and support staff and management were identified as factors that motivate nurses to remain in the hospital” (p. 6).
In this specific study, the authors focused on the factors that obstructed the adequate work of nurse interns, among which there is miscommunication, unfair treatment from the other staff members, and even exploitation, which are all elements of organizational culture. It can be argued that such problems inevitably affect the intrinsic motivation of nurses since lack of support and guidance from more experienced personnel is a barrier to better work and professional improvement.
It should be noted that the Qassim nurse population is not heterogeneous, because many expatriates working in the area, which creates a gap in the context of values and beliefs connected to culture. According to Altakroni et al. (2019), “in Saudi Arabia, cultural and language differences between expatriate nurses and patients affect the quality of nursing care” (p. 19). This information suggests that the motivation of nurses in Qassim is more complicated when compared to other states. To understand all motivation factors, a healthcare leader must consider the diversity of cultures.
The following studies focus primarily on the nurses’ motivation and specific factors that will be incorporated into this research. Hassankhani, Agdham, Rahmani, and Mohammadpoorfard (2015) found that self-efficacy impacts the motivation of medical personnel to provide quality services. Self-efficacy is a person’s belief that he or she is capable of achieving something and can be affected through proper organizational indulgement.
Kantek, Yildirim, and Kavla (2015) report that appreciation for the conducted work is essential for nurses. This study was conducted in Turkey, suggesting that the results may be specific for this population and the cultural environments. When combined with the outcomes of other studies focusing on nurse motivation, which were examined above, one can conclude that nurses cite different aspects of their work or personal characteristics as the primary motivation for work. Toode et al. (2015) report that the professional training received by nurses is an important motivational factor. These findings are helpful as they suggest that hospitals should focus on providing nurses with opportunities for further professional development.
However, these studies also point out several factors that cannot be impacted by an organization. For instance, Toode et al. (2015) found that the number of years a nurse worked at a facility impacts his or her motivation. Therefore, this evidence suggests that some aspects of motivation cannot be affected by management. However, healthcare leaders can assess the importance of these factors in their hospitals to gain more insight.
Therefore, based on the literature examined above, one can conclude that the central issue of the healthcare system in Qassim is quality improvement. This organizational entity is connected to the personnel’s performance and organizational climate. The underlying factor that determines the performance outcome is motivation, and because nurses are the driving force of any hospital since they provide the majority of patient care, it is vital to examine the actual factors that motivate nurses to work and address them through appropriate organizational culture.
The main critique of the existing literature is that while the presented studies outline various factors of nurse satisfaction and its impact on their work, they present contradictory results since they point put different motivational factors. Therefore, the research gap is the lack of a comprehensive study examining the motivation of nurses working in Qassim. The research results will provide the scientific community with the necessary knowledge on factors affecting nurse motivation in Qassim and how they are connected with patient outcomes.
Methods
Research Design
The study design is a cross-sectional observational study of the nursing population in Qassim. This is a quantitative assessment of nurses’ responses, which will employ a questionnaire as the central aspect of evaluation. The reasoning for this choice is connected to the specifics of the observation – the data, which is the nurses’ responses, will be collected at a given point in time, and answers of different individuals will be analyzed to locate a specific trend. This design was chosen because it can provide an instant assessment of motivation factors important to nurses currently employed by hospitals in Qassim.
Sample of the Study
The sample will have the following characteristics – nurses who have worked in the Qassim area for at least one year in any specialty or unit. The specialization of nurses or other characteristics such as age, gender, and additional training will not be included. Based on the literature review, one can conclude that the sample size of at least 20 respondents should be sufficient for adequate analysis. The primary exclusion criteria are a desire to quit working as a nurse since the responses of these individuals will obstruct an adequate analysis.
Research Instruments
A questionnaire is the main instrument that will be used for this assessment of nurse motivation. The main focus when choosing the research instrument for this study was the ability to distribute the questionnaire quickly and provide nurses with easy access. Considering this, online forms encompassing the motivation questions will be used in these studies, which will be distributed through emails using the Google Forms tool. This will allow the researcher to gain instant access to the responses and conduct an analysis.
Motivation Sources Inventory is the questionnaire that will be applied since this instrument was used in the studies examined in the literature review section of this paper. Barbuto and Scholl (1998) are the authors of the chosen instrument who developed it as an advanced method of assessing a person’s motivation (as cited in (Bodur & Infal, 2015). This approach implies the use of five subscales relating to motivation sources with six items of motivation per each source. Reliability is measured through Cronbach’s Alpha, while validity is assessed using ANOVA. In general, this method was chosen since it will allow assessing the internal and external sources of nurse motivation.
Data Collection
The study will rely on primary data collected from nurses in Qassim hospitals using quantitative data collection methods. Nurses’ responses will be collected through Google forms to evaluate the results digitally using methods of correlation and regression. This will allow nurses to present responses in a setting they perceive as suitable. Additionally, this will allow the researcher to collect a more significant number of responses since no face-to-face interactions with the participants will be necessary.
Spreadsheets will be used to organize the data and prepare it before exporting it to data analysis software. This choice is the most financially feasible option and will pose no hindrance in terms of extra time to set up the required environment and tools. Currently, both the Google Forms and Google Sheets are offered free of charge and can be easily distributed without conceiving risks of data loss and data tampering.
Data Analysis
The responses will be collected through Google Forms and exported to additional software for further analysis. The questionnaire will employ quantitative questions, such as multiple-choice questions. The validity of the findings will be tested using Cronbach’s alpha coefficient. ANOVA test will help measure the validity of results.
Ethical Consideration
The primary ethical consideration is ensuring that the personal information about the nurses is not disclosed throughout this study. No data such as names, age, place of work that will allow one to identify participants will be disclosed. The participants will be asked if they agree to share the collected information.
Limitation of the Study
An evident limitation is a region-specific focus since the research focuses only on nurses working in Qassim. However, as the objective is to gain insight that can aid leaders of the organizations in this region, one can argue that this limitation can be overlooked. The next limitation is the sample size since the study will use a limited number of participants. This issue can be addressed by employing statistical methods that will allow determining the reliability and variability of the findings.
References
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