Motivation of Employees in a Nursing Home

Chapter 1

Introduction

This sudden shift in the economic stability and job market has resulted in diminished passion and loss of productivity for many employees. As unemployment rate has drastically increased with a parallel increase in redundancy rate, expenditures have been cut down, demand for products and services have fallen and the fall in stock prices have led to depleted bank balances. Therefore, as organisations have downsized by cutting costs, job security, morale, contractual benefits and non contractual perks have all been affected and in many ways this has affected the motivation level of most employees. If employees’ motivational driving forces are blocked before they achieve their desired goal or ambition this would lead to either frustration or constructive behaviour which would eventually lead to lower or higher productivity depending on the outcome.

The term motivation is a familiar one. According to Martin (2005), within organisations, managers are constantly seeking ways to improve performance at every stage in order to raise productivity and reduce costs and a major element in this process is the application of practices assumed to contain the necessary motivational properties.

According to Martin (2005), there is no one theory of motivation that can be claimed to embrace the entire range of organisational and personal circumstances that exist. For example, something that motivates an individual today may not work tomorrow, yet may become viable again the day after, perhaps due to mood swings or factors outside of the work setting. Equally every individual employee is different and will respond to particular motivation processes differently. For example, the use of recognition and praise for good work may be motivational to one person, but yet have only limited effects for someone seeking to earn additional money to pay a large bank loan. Organisational circumstances also change over time which impacts on motivation practices.

In this research project, the author will discuss the factors which affect the motivation of employees in a nursing home within the context of content theories wherever possible.

Chapter 2

Literature Review

2. Motivation defined

The business encyclopaedia by the Gale group Inc, define motivation as “the ability to change behaviour, a drive that compels one to act because human behaviour is directed towards some goal”.

According to Daft (1997, p.526), motivation refers to “the forces either within or external to a person that arouse enthusiasm and persistence to pursue a certain course of action”.

Mullins (1996, p.480) suggests that the underlying concept of motivation is “some driving force within individuals by which they attempt to achieve some goal in order to fulfil some need or expectation”.

Moorhead and Griffin (1995, p.78) believe that motivation is “a set of forces that lead people to behave in particular ways”.

From such definitions it could be seen that motivation is a correlated relationship between attitude and behaviour and the need to act in a certain manner in order to achieve a certain goal or ambition.

2.2 Theories of motivation

There are many competing theories of motivation, all of which attempt to explain the nature of motivation itself. There is no general theory of motivation. The various theories put forward by writers in the field are not conclusive. Because of the complexity of motivation, there can be no single answer to what motivate individuals to work productively. Different theories provide a convenient framework within which attention can be directed to what and how individuals can be motivated willingly and effectively towards the company’s goal. Since the various and complex theories are not conclusive, each having their own critics, or having been subjected to alternative findings which claim to contradict original ideas, it is necessary to understand the different available theories and their accompanying implications. Thus, an evaluation of available theories is critical. Furthermore, it is possible to derive from them a basic overview and develop it in this thesis.

Theories on motivation have been around for a long time. Some of the early names in this field have been people like F.W Taylor, Elton Mayo and W F Whyte, however in this RAP, the author will only focus the content theories which are the works of Maslow (1943), Alderfer (1972), McClelland (1961) and Herzberg (1959) theories as otherwise the literature review would become too vast and complicated and would be difficult to connect with the survey carried out.

Motivation theories are classified into

Content theories which concentrate on identifying the motives that produce behaviour whilst

Process theories encourage (or reward) behaviour in the dynamic context. Another important concept in relation to motivation at work is that of an intrinsic and extrinsic motivator. Whilst Intrinsic motivators are those which originates inside an individual as a response to the job itself and the circumstances surrounding it extrinsic motivators by contrast are those which originates outside the individual worker and which influences their behaviour according to Martin (2005). These would include the work of Vroom/Porter and Lawler Expectancy models (1968), Adam’s equity theory (1965), Locke’s goal theory (1968), and Kelly’s attribution theory (1971).

Additional perspective on motivation have been introduced by McGregor’s Theory X and Theory Y (1960), Ouchi Theory Z (1981), Hofstede, Trompenaars and cultural influences on motivation (1980), and Maccoby’s social theory (1988) among various others.

Maslow’s hierarchy of needs

Maslow (1943) produced the idea that a hierarchy of needs could explain purposeful behaviour. The basis of this model is that individuals have innate needs or wants which they seek to satisfy and they have to satisfy the lower needs first before moving to the next level.

The figure below shows the model, indicating the hierarchical nature of the innate needs.

Figure 1: Maslow’s (1943) hierarchy of needs

The five levels included in the hierarchy can be defined in the following way:

Physiological needs. These include the needs for food, shelter, water to drink and sleep. In an organisational context this would also include the need for wages.

Safety needs. These include the need for shelter and protection. In an organisational context this would include the need for job security.

Social needs. These include the need for friendship and a sense of belonging. In an organisational context, this would include the need to work as part of a team.

Esteem needs. Incorporated in this category are concepts of achievement, adequacy, recognition and reputation.

Self-actualisation needs. This category is related to the opportunity to realise one’s full potential.

If applied rigidly, individuals have to satisfy one level of needs first before moving to the next level. However, this is not always true as human beings are not always predictable and have different needs depending on their circumstances and the time.

Alderfer’s Erg theory (1972)

Alderfer (1972) describes a three-level hierarchy, compared to the five levels proposed by Maslow. They are:

Existence needs. This category is grounded in the survival, or continued existence of the person. As such it would include many of the issues covered by the physiological and safety needs identified by Maslow.

Relatedness needs. This category is based on the need for people to live and function in a social environment.

Growth needs. This category is grounded in the need for people to develop their growth.

McClelland’s acquired needs theory (1961)

This theory develops a different set of needs as the basis of motivation:

Achievement motivation. This describes the need to attain realistic but challenging goals.

Authority motivation. This describes the need to exert influence, take the lead and make an impact.

Affiliation motivation. This describes the need to be liked, to be popular, to create friendly relationships and interactions with others.

Herzberg’s two-factor theory (1974)

According to Herzberg (1974) people are influenced by two factors namely:

Hygiene factors. The presence of these factors will not motivate individuals as such, but their absence will serve to create dissatisfaction with the job and organisation. These include salary, working conditions, job security, company policies, and interpersonal relationships at work.

Motivator factors. These are factors which could motivate the individuals to improve their work performance. They include factors such as recognition, sense of achievement, responsibility, growth and advancement.

Chapter 3

Methodology

The methodology section will be developed to present the basic research process that has been undertaken to approach the problem statement, the primary and secondary methods which have been used to collect data, the limitations of the research, the analytical perspective, findings as well as conclusions and recommendations. Furthermore, a thorough and extensive literature review was carried out in order to comprehend and clarify the author’s own concept of the factors of motivation.

A feasible way to collect the necessary data was found and the techniques required to carry out the research was implemented. Primary and secondary data was collected, analysed and findings has been explained.

3.1 Conceptual framework

Figure 2: the conceptual Framework

3.2 Topic selection

This particular topic was chosen for various reasons. Fisher (2007, p.31) suggests relevant factors, which were taken consideration when choosing the topic. The topic chosen was both contemporary and challenging. Many researchers have written extensively on the subjected matter and it has been tested time and time again. This topic is still very relevant in this modern economy. The author chose the nursing home as the field of interest and factors of motivation as the main focus. Nursing home is a huge booming business in the United Kingdom. There are about half a million care places in residential and nursing homes in the United Kingdom with a combined stock market worth of 375 m pounds.

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Figure 3: cartoon of employees described as assets

Chapter 4

Background of Four Seasons Health Care

Four Seasons Health Care owns and operates over 400 nursing and Care Homes and Specialised Care Centres in England, Scotland, Northern Ireland and Isle of Man. The Company is one of the largest independent providers of care services in the United Kingdom. Four Seasons’ origins date back to the late 1980’s.The company has developed through both the acquisition and construction of care facilities and has firmly established a reputation for professionalism in all aspects of its care operations. The company employs over 21000 staffs. Norwood Green Nursing Home is a branch of Four Seasons Health Care.

4.2. Management Style

Pete Calveley, Chief executive of the Four Season Health Care, believes that despite the market being very challenging right now in the turbulent economic times, the company has out-performed many of its key competitors because of their vision, good management styles, specialisation, employees’ loyalty, clarity, reputation and quality. He states “At Four Seasons, I believe that we meet this challenge to an extremely high standard. I believe that the motivation of our employees is as high as can be found anywhere and this results, directly, in the delivery of a better standard of care”.

4.3. Background of Norwood Green Nursing Home

Figure 4: The organisational structure of the nursing home is as

The nursing home is over three storey floors with 120 beds. It employs over 60 staffs, with a combination of permanent and part time staffs. The choice of site was dictated by local conditions and it was more feasible to analyse the effect of a single company’s structure, personnel policies and social atmosphere on the employees’ level of motivation in their work.

Norwood Green Nursing Home has a democratic style of management where the employees are consulted on issues that concern them; there is a two way communication process however major decision in line with the strategic objectives ultimately lies with the general manager. This style has close links with Maslow’s (1943) higher level of needs, Herzberg’s motivators and McGregor’s theory Y.

4.4. Research Objectives

From the inception of this thesis to its conclusion, the objective hasn’t been altered. Hence, the basic and significant aim of this survey was to demonstrate the factors which affect the motivational level of employees which would eventually increase productivity, lower employees’ turnover and increase profits.

4.5. Research Design

From the survey of literature of correlated studies and findings from the pilot study, a questionnaire was designed. The research method created for this study employed a survey questionnaire method. Recognition of the limitation of the pilot survey led in developing the questionnaire, questions were added to ensure that an in depth analysis could be deduced. This was done through a mixture of dichotomous questions, Likert response scale and the information was collected through use of a written questionnaire hand-delivered to participants and collected in person. The questionnaire contained 10 questions which were simple and served the purpose of the research. The content of the questionnaire has been included in the report. The surveys from the employees are summarised and the data analysed in this report. As a result of the pilot study, minor amendments in the structure, word selection and instructions on the questionnaire were made.

4.6. Ethical considerations

The survey was carried out in line with ethical guidelines. Permission was asked beforehand for the employees’ participation. The respondents were informed about the questionnaire in an honest way and its purpose for the RAP. None of the employees were forced to answer any questions. They were free to leave the questionnaire if they wished to do so. The questionnaire was constructed in a fair way without offending any of the employees. The responses were kept confidential and to ensure anonymity the questionnaire did not contain anything that could identify the respondents.

4.7. Validity and Reliability

Validity is the amount of systematic or built in error in measurement according to Norland (1990). Validity was established by ensuring that the questionnaire contained all the data required to fulfil the purpose of this research, ensuring that the instrument looked like a questionnaire as well as ensuring that the questionnaire was comprehensive enough to collect all the data necessary to address the purpose and goal of this research. Reliability was established using a pilot test by collecting data which was not included in the sample size as well as giving the respondents chosen the same questionnaire on two separate occasions where the response was the same.

Chapter 5

Data collection

Collecting the primary data was done through a research questionnaire. In order to reduce the scope of the data collection only a sample was used, which was the group of nurses.

The design of this study emerged slowly through a couple of stages. Foremost, a pilot survey was designed to test the feasibility of the approach. All the employees of the company came from a wide variety of background. They ranged in age from 21 to 72 years. The population comprised of 10 general manager, 22 deputy manager, 33 nurses, 8 activity coordinators, 12 chef, 10 kitchen assistants, 25 clerical workers, 20 maintenance men, 25 care workers and 5 cleaners, were asked 3 questions each

Were they satisfied with their current job

What were the motivational factors behind their job

Did they think that their individual needs differed from their co workers

However, it wasn’t possible to develop and analyse from their responses a coherent picture of the factors affecting their motivation. The target population was too diverse and vast as it ranged from upper management to bottom of the hierarchy. The responses received were too random and didn’t make a true and fair representation of the subject matter being investigated as the variables were too unrelated to each other. The effects mentioned were too many and varied. Although the method did not have to be modified, a further decision was made concerning the population to be approached.

5.1 Sample size

On the basis of the experience with the wide range of positions covered by the first population who were questioned, it was deduced that the focus individuals for this survey were nurses at the nursing home. This decision was based on two considerations. First, they made up half of the workforce at the nursing home. The secondary consideration was that they gave a fair representative of the workforce and were adequately represented as argued by Walliman (2004). Furthermore, the problems of obtaining access to this group were minimal. This had more statistical precision as it was deduced that the variability within groups is lower than the variability for the population as a whole as groups are more homogeneous. A group can be viewed as having a structure or form. All of the 25 nurses working at the nursing home were requested to participate in the survey and the participation rate was 100%. However, the total participation to the whole population of employees of the nursing home was 42% as there were a total of 60 employees together with part time and permanent staffs. All of the nurses were degree level educated and had a proficient understanding of the English Language. Access to the nurses was also done on a limited basis as the author did not wish to impose on their time and busy daily routine. All the information needed was acquired quickly and ensured the privacy of the employees and residents of the nursing home.

5.2 Resources

There is a lot of information available on this subject matter on the World Wide Web as well as books and articles demonstrating a varying and interesting perspective of opinions. This allowed the author to explore as many different theories as possible to derive an accurate comprehension of the subject matter in the available time limit. The information collected through the survey was transferred to Microsoft Excel to be analysed and graphs were generated. According to Fisher (2007), there is no need to use complicated software to analyse questionnaires when the respondents are less than 30.

Chapter 6

Results and Discussion

Descriptive and Inferential statistics

This would be to provide a summary about the sample and the measures. Together with simple graphics analysis, they would form the basis of the quantitative analysis of data.

Question 1

The majority of the population questioned were females. The respondents stated that more women than men preferred to work in the nursing profession as women were seen to me more natural at the nursing job than men. According to the Nursing Online Education Database “recent surveys show that less than 6% of all registered nurses are male and men have sometimes hesitated entering the nursing field, as it is often misconstrued as a career for women”. A further question was asked as to why the respondents chose this profession. The majority of the respondents stated that it was because they wanted to be recognised for their positive contribution to the health of others and provide them the opportunity to maintain their independence whilst gaining the respect of others. A comparison of this response to Maslow’s (1943) hierarchy of needs theory places this on the level of the esteem needs where employees strive for independence, recognition, status and respect from others. Interestingly, this corresponds with Herzberg’s (1974) two factor theory where employees are categorised by the motivator factors, one of which is recognition and a sense of achievement and this need for personal growth motivates the employees to superior performance.

Question 2: On average most of the employees worked in the home between 5-10 years and all of the employees were permanent staffs.

According to Maslow’s (1943) hierarchy of needs theory, safety needs is a motivating factor for employees and taking that into consideration, as the survey shows 56% of the population have been in the same employment between 5-10 years which is a long commitment. When questioned further, the respondents stated that they had reached their “comfort level” and did not feel that they needed to relocate their job. Most of the employees were also local residents and did not wish to commute far for employment. Therefore, as the employees felt secured and comfortable in their jobs, they did not want to leave their “safety niche”. This corresponds with the second level of Maslow’s (1943), hierarchy of safety needs where employees have to have a safe working environment where they feel their jobs are secured. This is a powerful motivator as according to Maslow (1943) people cannot move on to the next level of the pyramid unless the safety needs is satisfied. This response could also interchange with the lower level of the pyramid which is physiological needs – the need for food and shelter as the employees viewed their job security in the same level as having their basic necessities. This could provide as a good indicator for management as this is a powerful and important motivator.

Question 3: 15 of the 25 nurses questioned replied that they were highly satisfied with their job, 9 of the nurses stated that they were satisfied whilst only 1 of the respondent replied that they were not satisfied.

Satisfaction could be seen as an important factor in the motivation of employees. Many of the theorists have attempted to explain this specific factor. The response of the nurses would actually reflect in the self-actualisation level of Maslow’s (1943) hierarchy of needs where employees have reached their potential and are completely satisfied with their level of achievement. However, to rigidly follow this theory this would imply a strict application of this theory where each of the lower needs have to be satisfied first before moving to the next level. This theory did not hold true to the survey carried out though as the respondents stated that this factor was more important to them to perform better in their job than actually the need for relationship and affection which is a lower need in Maslow’s (1943) hierarchy of needs. According to Herzberg’s (1974) two factor theory, satisfaction also prompt employees to perform better in their jobs.

Question 4: 9 out of the 25 respondents replied that they were highly satisfied, 12 respondents stated that they were moderately satisfied and 4 of them stated that they were slightly unsatisfied.

The 36% of the respondents who stated that they were highly satisfied with the level of support from the management felt so because the management was very ‘hands on’ and were willing to help with complicated problems at work such as aggressive behaviours from patients and so on. The 48% of the respondents who were moderately satisfied stated that at some point or other of their career, the management had helped them on a personal issue. The 16% who were slightly unsatisfied felt so due to stress of over load of work and did not feel that the management were helpful enough to relieve the pressure.

Question 5: 100% of the employees stated that the management involved them in the decision making policy affecting their department.

The respondents stated that they were completely involved in decision making processes which affected their departments. Being empowered and involved ensures that employees are being kept informed about changes regarding their jobs. Having an open line of communication between management and employees ensures that employees are being appreciated about their contribution to their job which boost their morale and help them to achieve their best potential in their job. Employees, who are involved and empowered feels that they are recognised for their professionalism, make them feel responsible and important to the company. This in itself is a powerful factor of motivation for employees.

Question 6: 14 out of the 25 nurses stated that they did have the same vision and value as the nursing home, 2 stated that they did not and 9 remained neutral.

48% of the group stated that the company had a set goals and objectives which it shared with the employees in order to keep a solid vision in their workplace. The 8% , however, did not feel that the company vision served them as a guide and inspiration and did not reflect their own values and vision.

A correlation of the values and vision of employees with that of the company helps to employees feel more related and committed to the company which acts as a motivator for better improvement in their jobs.

Question 7: 10 out of the 25 respondents preferred to have more responsibility and control, 10 of the respondents replied that they were satisfied with their level of responsibility and control whilst 5 of the respondents preferred to remain neutral.

40% of the group surveyed preferred to have more responsibility and control as

The 40% of the group who were satisfied with the level of responsibility and control stated that they had a schedule to work with and a clear set of policies which gave them more control over their daily routine and made them perform better and smarter and that proved to be a motivation in itself.

By giving employees more responsibility and control by having a clear direction with parameters to work within broad outlines, it demonstrates to employees that management have trust in them and value their judgement and decision. This helps to motivate employees to do better at their job and be more productive whilst saving time. Alderfer (1972), incorporate this factor in his growth needs theory, where individuals have the need to develop their potential by taking on more responsibility and control.

Herzberg (1974), categorises this need in his motivator factors where people are motivated by responsibility, growth and advancement.

Allowing employees the job control and responsibility by issuing clear objectives, planning, responsibility, challenge and accountability increases their motivation level which in turn reduces cost and increases the quality of service.

Question 8: 100% of the respondents stated that they worked well in team work.

Interestingly, all the respondents stated that they worked well in a team. Working together in a team is a powerful factor of motivation as it gives employees the opportunity for personal and professional growth. It empowers them to feel a sense of achievement, receive instant feedback, provides them with an opportunity for advancement as well as having an opportunity to take more responsibility. Furthermore, having stimulated and motivated employees enhances productivity, creates quality conscious actions and performance related behaviours.

Diversity of life experiences and working styles can bring different talents and variety of skills together by working effectively in a team. The respondents stated that they shared a common goal which enabled them to work better in a team. This corresponds with Maslow’s (1943) social needs where employees are motivated to work as part of a team in an opportunity to feel belonged and sustain friendship. Alderfer (1972) also categories this in his relatedness needs where people embrace the need to be part of a group and belong to a valued organisation. In his motivating factor, Herzberg ( 1974), also emphasises the need for individuals to work together in order to feel responsible, have a sense of achievement as well as an opportunity for growth and advancement.

Question 9: 12 out of the 25 respondents responded that they had a sensible and reasonable work-life balance, 8 of the respondents stated that they did not think that they had a good balance whilst 5 of the respondents remained neutral.

Having a reasonable and sensible work-life balance is a crucial motivator for employees as not being able to meet the demands of their lives beyond the workplace can leave employees with feelings of frustration and dispassion of their job which could reduce their productivity, quality of work and morale.

The 32% who disagreed that they had a reasonable and sensible work-life balance stated that they were constantly being put under pressure to work overtime and that did not leave them with much time for the demands of their private lives. This was increasing their stress level and causing them to be overwhelmed at their jobs.

Furthermore, a reasonable work-life balance acts as a strong factor of motivation for employees as this reduces stress and sickness days, increases morale, physical and emotional well being. Moreover, it increases job satisfaction and improves employee retention.

Question 10

The respondents’ preference to the factors of their motivation is depicted in the chart below according to their importance. Job security was seen as a very important factor of motivation whilst supervision and appraisal ranked in last.

The rank of importance was as follows:

Job security

Career progression and professional growth opportunities

Good working conditions and good wages

Good relationship with colleagues and management

Status recognition

Challenging and interesting work

Personal loyalty to colleagues and management

Effective health and safety policies implemented in the home

Periodical performance related supervision and appraisal procedures

Empathetic help with personal issues

Job security, career progression and professional growth opportunities, good working conditions and good wages

Job security ranked the most important by the employees in this survey, career progression and professional growth ranked the second whilst having good working ranked the third. Exploring this further, most of the respondents stated that having a job security with less pay was more important to them than having a good wage with less job security as this ensured their financial stability especially in this turbulent economic climate to be able to make their financial commitments such as their mortgage payments, bills payments, family upbringing and so on.

Progression and professional growth opportunities ranked as the second most important factor of motivation. The respondents expressed that they wanted to be able to have opportunities in their profession and being able to have this motivated them to work harder and strive to perform their best as they stated that they had a goal to work towards.

Having good working condition at their job was as equally important to the respondents as getting good wages. Having good working conditions motivate employees to enjoy their work, boost their morale, perform efficiently in their job and enabled them to getting a good wage. The respondents stated that good wages were not their priority motivator as it was only materialistic enabling them to have a good standard of living whilst having good working condition meant that they were not mentally exhausted from having to deal with stress at work.

According to Herzberg’s (1974) two factor theory job security is a hygiene factor rather than a motivator and the absence of this