application of herzberg's motivational theory on a surgical unit;
TRANSCRIPT
AI.'l APFLICA nON OF
HERZBERG'S MOTIVATIONAL THEORY
ON A SURGICAL UNIT
by
Tanna S. Ferrin
A thesis subnitted to the faculty of the University of Utah in partial fulfillment of the requirements
for the degree of
Master of Science
College of Nursing
University of Utah
March 1978
THE UNIVERSITY OF UTAH GRADUATE SCHOOL
SUPERVISORY COMMITTEE APPROVAL
of a thesis submitted bv
Tanna S. Ferrin
Judith Kiernan Graff Chairman. Supervisory Committee
I have read thIs thesis and have found it to be of satisfactory quality for a master's
degret:.
3) 7 J 7 r? Date
David w. P�ston \1ember. Supervisorv Committee
I have read this tht:sis and have found it to bt: of satisfactory quality for a master's
degret:. ,
.3/e·4 .!" Date / 7 /
THE L"IVERSITY OF l'TAH GRADL'ATE SCHOOL
FINAL READING APPROVAL
To the Graduate Council of The University of Utah:
I have read the thesis of Tanna S. Ferrin in its
final form and have found that ( I) its format. citatlOns, and bibliographic style are
consistent and acceptable; (2) its illustrative materials including figures. tables, and
charts are in place; and (3) the final manuscript is satisfactory to the Supervisory
Committee and is ready for submission to the Graduate Sc:r.ool.
Member. Supervisury Cummittee
AP�roved for the Major �epartment
.�.
Dean Madeleine Lain' ger Chairman. Dean
Approved for the Gradu:lte Council
ABSTRACT
This study explored the relationship between the application
of a method to increase levels of motivation and the resultant
change in measured levels of job satisfaction and turnover rate.
It demonstrated that it is possible to increase job satisfaction
and decrease the turnover rate in hospital nursing. The study
group involved was the nursing staff on a 42 bed general surgery
unit in a 330 bed general, nonprofit hospital. The method chosen
to increase the level of motivation was an application of
Herzberg's Theory of Motivation.
Herzberg's Theory of ~otivation states that job satisfaction
and job dissatisfaction are two separate, unique attitudes. ~~ey
are not on the same continuUM; L~stead, they are separate unipolar
concents. A person can experience high or low job satisfaction
and high or low job dissatisfaction at the sama time. Herzberg
has determined that different factors determine job satisfaction
and job dissatisfaction. Job satisfaction is determined by
achievement, recognition, work itself, responsibility, advancement,
and DOssibility of growt~. These factors he termed motivator
factors. Job dissatisfaction is determined by company policy and
a~~inistration, supervision, salary, interpersonal relations,
working conditions, status, job security, and the effect on ger
sonal life. These factors are called hygiene factors.
~~tivator factors were provided to the staff on the study
unit through the initiation of activities thought to provide
those factors. The activities included cc~~ttges, aide skill
classes, inservices, team conferences, te~~ rounds, a pre-op
teaching program, a unit problem solving method, an interpersonal
problem solving approach, individual projects, and comprehensive
patient care. The level of job satisfaction and the turnover rate
~ determL~ed before and after the motivator activities were
initia.ted.
The level of job satisfaction was determined by obtaL~ing
written responses to a questionnaire designed by Herzberg to
determine if a staff identified any changes in their work, how
they felt about the changes, and if they saw an increase or a
decrease in the six motivator factors. Another tool was given
which asked the staff to rank various hygiene and motivator
factors in order of importance for an ideal job. The turnover
was determined by dividing the total number of terminations a.nd
transfers from the unit by the total number of employees.
The effect of the motivator activities upon the staff was
rate
determined by comparing the data obtained in the Dre and posttests
on the experimental unit as well as comparing the pre and posttest
data obtained from control units. The motivator activities were
introduced only on the experimental unit. No changes in hygiene
practices were planned on any of the units a.s part of ~~is study.
Therefore, differences noted in the pre and posttest data on the
v
experimental unit and between the experimental unit and the
control units could be attributed to the implementation of the
motivator activities.
Based upon the findings, the research hypothesis that the
measured level of job satisfaction L~ a group of nurses would
increase if motivators were provided was only weakly supported.
Supporting the hypothesis was the fact that the expertmental unit's
staff reported their amount of satisfaction had increased to a
significant level. However because the control units also re
ported an increase in their amount of satisfaction and because ~~e
experimental unit's staff saw an increase in only two of the six
motivator factors, the hypothesis could not be strongly accepted.
The second hypothesis tested by this study ~as that the turn
over rate in a group of nurses would decrease if motivators were
provided. The turnover rate was lower during the nine month
experimental period than it was during the same nine month ?eriods
of the two preceding years. ~~ile this decrease appeared large,
from 6l~ in 1975 and 56~ in 1976 to 43% during the study, the
decrease was not statistically significant. Therefore, the
research hYF~thesis that the turnover rate would decrease if
motivators were provided was not statistically supported.
The failure to support the research hypo~~esis could have been
due to the fact that all of the planned ~otivator activities were
not successfully completed. Also the results obtained from the
questionnaire indicated that the staff did not recognize the
vi
planned activities as motivators and that the ~otivator activities
planned did not change the ~ork enviro~~ant in such a man~er that
it was completely meeting the s~aff's needs.
Further study attempting to increase the level of job satis
faction ~ust be continued. However, different motivator activities
supporting Herzberg's Theory of ~~tivation need to be tried.
rti
The writer wishes to acknowledge the invaluable support of
many individuals who assisted with this nroject. The contribution
of so much tL~e and interest from Judy Graff is sincerely appre
ciated. Also appreciated is ~~e support and assistAnce received
from the other supervisory committee members, Maeona Jacobs and
David Ralston.
Deepest gratitude goes to Pat Hanson for her continual
encouragement and editorial assistance, to the nursing personnel
who participated in the study, to the members of the Nursing
Administration Department for their support, but most important of
all to my family.
ABSTRACT • • ••
ACXNOfLEtGMENTS
LIST OF TABlES •
CHAFTER
TAELE OF CONTENTS
. . . . .. . .
I. INTRCCUCTION • • • • • •
II. REV:w.i OF THE. LITERATURE
III. CONCEPTUAL FRAMEWORK AND METHODOLCGY
IV. FINDINGS " • • • • • • • • • • •
v. DISCUSSION AND RECOMMENDATIONS
APPENDIX
G • • • •
A. MOTIVATOR ACTIVITIES AND CCRRESPONDING MOTIVATCR
Page
iv
viii
x
1
5
22
52
71
F ACTCRS AND ORTHODOX JOB ENRICHMENT INGREDIENTS • 84
B. JOB SATISFACTION AUDIT • • • ? • • • G
C • YOUR IDEAL JOB • •
D. 31 CGRAPHICAL DA TA •
3. DATA FROM JOB SATISFACTION AUDIT
F • DATA FRCM CHANGES IN POSITIVE AND CHANGES IN NEGATIVE FEELINGS
G. DATA FROM YOUR IDEAL JOB . . . . REFE..ttENCES • . . " VITA • • " • •
. . . .
. . .
86
90
92
94
106
III
120
124
LIST OF TABlES
Ta.ble Page
1. TURNOVER RATE • • • • • • • • <I 0 • • <I • . . . •• 54
2. AVERAGE MONTHLY TURNOVER RATE 0 • • • • • • • • o. 55
3. TURNOVER RATE TEST OF SIGNIFICANCE •• . . . 4. CO~~ARISICN OF JOE SATISFACTION AUDIT
DATA AMONG UNITS • • • • • • • • • • • • • • <I 59
5. 3C POSTTEST • • • • • • • • • • • • • • • • • • 61
6. MEAN SCORE FCR CHANGE IN POSITIVE AND
NEGATIVE FEELINGS • • • • • • • • • • • • • • • •• 6)
7. POSITIVE .I\ND NEG.4TIVE FEELING TESTS OF
SIGNIFICANCE • • • • • • • • • • • • • • • • • •• 65
CHAPTER. I
INTRODUCTION
The past 100 years have witnessed a drama tic change in the
nature and meaning of employment to man. ;~ork has changed from
simply providing people -Nith a paycheck enabling them to survive
economically to becoming a means of satisfying many other needs.
In the late 1800s and early 1900s, the concern of management was
primarily to establish the sL~plest ~ethod by which any given task
could be performed. Soientific management divided jobs into small,
easily learned routines; efficiency experts determined the most
productive way of performing ~~ose routines; and the worker had
only to follow the specific steps without any variation. People
were considered machines. Creativity a.nd the need for individual
thinking were planned out of a. job because management felt that
increased productivity resulted when passive individuals simply
performed the predesigned tasks without questioning or thinking
about them (Howell & Eoxx, 1973).
In recent years, as economic conditions have improved and our
standard of living has risen, managementts emphasis has changed
from ~~e ,job itself to the person performing that job. It is
recognized that people have many needs other than just surviving
economically, such as tr.? need :'or esteem a..-.,d self -fulfillment.
For many workers the satisfaction of other needs is just as impor-
2
tant as economic survival. A problem that ~anage~ent faces is
insuring that its emnloyees are motivated to perform at their
highest capabilities. A person is motivated to perform well when
that performance satisfies needs (Longest, 1974; Vonder naas,
1971). :iork itself is an L~port~~t way in which a worker can
satisfy needs. In an attempt to increase productivity and to
obtain a product of higher quality, management is exploring
methods to improve employee motivation throu~h greater need satis
faction.
In addition to the change in the meaning of work to employees,
much of the urgency to discover improved motivational me~hods
results from our economic conditions today. The health care
industry is especially affected by this because health care
expenses have been increasing at a rate of 15% a year, or twice
the national inflation rate. At this time, hospital expenditures
alone equal $55.a billion per year and hospital expenditures are
only 40~ of the annual health care costs which are expected to
total $160 billion in 1977. At the current rate of increase,
hospital expenses alone are expected to double in five years to
$110.8 billion per year. Currently every man, woman, and child in
the United States pays an average of $700 a year for health care
(Putzel, 1977).
Associated with the sharp rise in the cost of health care is
a developL~g consumer demand for high quality but econow~cal
health care. This de~and forces the health care providers to look
for methods of more efficient utilization of their employees.
This affects the nursin~ profession since nurses are the largest
single health emoloyee group (American Nurses Association, 1974;
Levine, 1969). However, nursing is plagued bJ~ many problems,
such as a high turnover rate, role confusion, and a low level of
job satisfaction. These problems adversely affect the quality of
patient care being provided. The need for an improved level of
motivation in nursing is becoming essential, not only because of
the economic push for increased efficiency, but also because
nurses are demanding that work satisfy more of their needs. In
some instances that demand takes the fo~ of formal organization
into union and bargaining groups. Other examples inclUde the
large number of nurses who wander from job to job hoping to find
one that can satisfy many of their needs and the nurses ~~o drop
out of nursing to enter other professions.
This study was designed to explore the relationship between
the application of a method to increase levels of motivation and
the resultant change in the measured levels of job satisfaction
and turnover rate. The nursing personnel involved was the RN,
LPN, and nurse aide staff on a 42 bed general surgery unit, known
as 3e, in a 330 bed general, nonprofit hospital. There were
obvious indications of a low level of motivation. One dramatic
indication was a high turnover rate. In 1975 the turnover rate
for all levels of the staff was 88~. In 1976 the rate remained
excessively high at 76{.
This high turnover rate was one indication of a low level of
job satisfaction on JC. The unit also tad the reputation
4
throughout tl:e hospital of being a grcup of unhappy nurses.
~Jursin€ c..arsonnel frem other units and from the float pool found
them to be unfriendly and unhelpful. After ';Arorking ~ri t.."1 this
group for a year, the author felt the staff had minimal pride in
themselves as a work group. Participation in unit activities ;.ras
nonexistent. Unit activities included eve~~ing from unit
parties to inservices to planning changes for the unit. 'rI:e)C
staff cam.e to work as required, put in eight hours on the job, and
carried out the required nursing" ca.re. They volunteered no extra
effort or time to improve the unit or its method of providing
care. To gain a.ttendance at staff meetings and unit inservices
it was neicessary to make attendance a stipulation for obtaining a
yearly meti t raise. The staff did not voluntarily get involved
in solving unit problems or planning needed chan~es.
The need for an improved level of motivation on JC was
urgent. The problem to be solved was how to increase the level of
motivaticm in those individuals; or, more specifica.lly how to
change the job so that it could meet their needs. It was hypoth
esized that an increased level of motivation would result in an
increased level of job satisfaction and a decreased turnover rate.
CHAPTE.:=? 2
R~~S~ OF THE LIT~~TURE
Considerable research has been done on the effect of
improving employee morale. High levels of job satisfaction have
been demonstrated to be correlated w~th lower rate of absenteeism
and turnover (Brayfield & Crockett, 1955; Slocum t SUS~~t &
Sheridan t 1972; ~.,roolf, 1970). One of the nursing profession' s
most serious problems today is an ext~emely high turnover and
dropout rate. The seriousness of this high rate can be appre
ciated 'When the projected demand for nurses 1s compared to the
perceived shortage of nurses.
The demand for nurses 1s greater today tilan it ever has been.
There are two basic reasons for this: 1) the rapid improvement
in medical knowledge as reflected by Levina (1969) in his comment
that 'f ••• in the past 15 years there have been more advances in
methods of diagnosing and treating physical illnesses than had
been made in the preceding 1500 years" (p. 292); and 2) the
nature of nursing has changed dramatically. Medical care today is
becoming more patient-centered and exists on a continuum from
health maintenance to rehabilitative and restoratiYe. The nursing
profession plays a vital role in all of these areas. Thus, the
need for nurses continues to grow.
The anti~ia:cated shorta€e of nurses is demonstrated by several
6
studies. Lysaught (1971) listed ei~ht previous studies of
nurses related to projections of nee";, del'iand, and su'Cply. Every
study predicted a shortage of nurses in the future no matter
whether requirement was measured Oy a projection of need, as
determined by professional judgments of standards considered to
produce optimum nursing care, or demand. as documented by total
bud~eted positions.
In view of the reported antiCipated shortage of nurses it is
startling to realize that the actual supply is sufficient to meet
that shortage. For example, in December 1971 the median vacancy
rate in large, nonfedera1, short-term general hospitals was 5.0%0
However, in that same year 316,611 RNs were inactive (American
Nurses Association, 1974). In 1972 over one million RNs held
licenses but only 6~ of those RNa worked in the nursing profes
sion (American Nurses Association, 1974). In 1973 Lysaught
estimated there were 1,400,000 RNa. Of that number, one in four
was totally inactive. Another one out of that four maintained a
license but did not work. Of the remaining 5~, one in three RNs
worked only part-time. This left an estimated 525.000 full-time,
employed RNs. That number included nurse educators, administra
tors. supervisors, and practitioners. These facts demonstrate
that the shortage of nurses stems not from the actual supply of
prepared nurses but instead the shortage is due to the large
number of non-practicing nurses.
Two studies conducted by Kramer and Baker (1971) illustrate
the large dropout rate in nursing. In t~e first study they
defined dropouts as "those nurses who expressed much dissatisfac
tion with nursing practice and left it to take a job or to
prepare for jobs in some other occupation such as business,
teaching. physical therapy, and so on tt (p. 20). Those who
withdrew for marriage or motherhood were not included. The first
study was done on the total graduating classes of three Nursing
Programs at California State College. It was discovered that an
11% dropout rate occurred after two years of employment. In the
second survey, dropouts were defined as "nurses who withdrew from
the practice of nur~ing because of dissatisfaction or alienation,
or both" (p. 23). This study. which was nationwide, detected a
28.9% overall dropout rate. If those who went into teaching or
preparing to teach were included because of the assumption that
those nurses were also withdrawing fram the practice of nursing.
the rate increased to 33%.
7
Not only are nurses dropping out and not practiCing nursing
but those employed are also moving fram one nursing position to
another at a startling rate. This is not a new phenomenon. Three
studies conducted bet~N8en 1955 and 1960 demonstrated annual turn
over rates in nursing from JJ% to 90% (Dodge, 1960; Hough, 1955;
Levine. 1957). Those rates are especially dramatic when compared
to the 18% average "quit" rate for all federa.1 employees (Rough.
1955)0 Later studies ha.ve continued to demonstrate an excessively
high turnover rate. Lysaught (1971) determined the annual turn
over rate of all nursing personnel to be 59%, administrative and
supervisory nursing personnel 21'1. LPNt:; JB%. RNs 75~, and aides
?6~. Many Pdople attribute the high turnover rate in nursing to
the fact that it is la.rgely !i Homenfs profession. However,
Lysaught cOMpared the turnover rate of nurses to that of public
school teachers thinking that the two occupation~ should b6 COM
parable in terms of sex linkage, socia-economic background, and
general salary conditions. He found the annual turnover rate of
teachers to be only l~, much l~~er than that found with nurses~
Later Lysaught (1972) discovered a 70% national avera~e turnover
rate in nursing with tha.t rate going as !1igh as 150-200'~ in
metropolitan areas.
No Matter which statistics are used, the nursing turnover
rate is too high and compounded with the high dropout rate causes
serious problems for hospital and nursing a~~inistrators. This
high rate adversely affects the quality of nursing care being
given as new, inexperienced nurses or experienced nurses who are
not well oriented to a new hospital are the ones left at the
patient's bedside.
Another serious problem the high turnover rate poses is an
economic one. Labor consumes 60-7~ of a hospital budget, a
substantial pa~t of which ~ust then go to re~lacing nurses.
Reported cost levels required to replace an RN vary considerably
dependine upon what is included in that expense. Dane (1972)
found a low average cost of re~lacing an RN to be ~420. The costs
ranged from $16 for a rehiree to $829 depending upon the length of
orientati()n required o Abla and Breeden (1972) estimated that it
cost $729 to replace an RN and S51Q to replace an LPN in the
Denver. Colorado area. Tuchi and Carr (1971) studied seven
nonfederal, short-term, general ~ospitals in an eastern metro
politan area. They calculated the total turnover costs at
9
$1,335 for an RN, $1,133 for an LPN, and $829 for an aide. The
hospital in which this study was conducted estL~ated that it cost
$1200 to replace an RN in 1977. Thus if a hospital has a 7~
nursing turnover rate each year, and it costs$IOO to replace each
one of those nurses, the yearly cost of turnover has a very large
impact on the cost of health care.
~~y does nursing have such a high dropout and turnover rate?
Studies have detected various reasons for these problems, and,
as with the reported turnover rates, these reasons have been
consistent from 1958 through recent studies. It appears that two
thirds of the nurses who leave jobs do so for "nonvoluntary or
unavoidable reasons" (Catania, 1964; Diamond & Fox, 1958; Lyons,
1970; Saleh, Les, & Prien, 1965) such as moving out of the city,
pregnancYt getting married, caring for their family, family health
problems, home responsibilities, poor health, retirement, com
pletion of education, conflict with husbandts work t husbond going
on to school, and involuntary termination.
However. it is thought that the other one third of nurses who
left for "volunta.ry reasons" oan provide the most valu3.ble infor
mation on how to increase job satisfaction and decrease turnover
rates. In the Catania (1964), Lyons (1970), and Saleh, Lee, and
Prien (1965) studies the following reasons \,;tere given for voluntary
turnover (this list is not in any particular order):
1- Taking other jobs 2- Dissatisfaction ~~th job or hospital 3- ~ature of ~ork: hours of work, heav~ work load,
not usL~g experience or ability, too much pressure 4_ Lack of promotion 5- Need for new experience 6- Unclear rules, regulations, and lL~its of authority 7- Supervision and human relations: not treated fairly,
did not like supervision, good work not recognized, difficulty in exchanging information with others about the job
8- iI/ages 9- Fellow TNOrkers
10- Inadequate explanations of decisions affecting the job
11- Poor planning
The important realization developing is ~~at wages and the
hours worked are not the major reasons for nurses quitting as it
10
has been assumed in the past. Popular opinion has been that ~uch
could not be done to decrease the turnover rate in hospital nursing
since the hours of work and the wages paid could not be drastically
altered. Hospitals require nurses 24 hours a day seven days a
week and increasing nurse's salaries would necessitate raising
hospital costs. However higher wages and better working hours
consistently are of low importance in studies dete~~ning why
nurses leave their jobs (Benton & ~hite, 1972; Everly & Falcione,
1976; Kr~~er, 1969b; McCloskey, 1975; Saleh et al., 1965; Nright,
1957) •
A study by McCloskey (1974) supported findings that external
rewards draw a person to a job but internal rewards keep that
person there and stimulate him to perform well. In c~~er words,
when a nurse is looking for a new job wages, benefits, and time
off are the most importan t ccnsidera tions; but i-;hen she is
11
deciding whether or not to stay in a nursing position the deciding
factors are the sccial and psychological rewards being received.
Thus the ~ain reason nurses are terminating their jobs is that they
desire more social and psychological rewards than are currently
being provided.
Generally, the social and psychological rewards that nurses
want from work are derived from communications, role definitions,
supervision, relationships wi~~ co-workers, opportunity to use ~~eir
experience and ability, learning opportunities, clinical advance
ment, and recognition. Specifically, ~1aryo and Lasky (1959) found
that nurses wanted a larger nursing staff, improved communications
with other professional staff members, and better definitions of
nursing duties. \o/right (19.57) found good supervision and communi
cation decreased the turn,over rate. In the Saleh, Lee, and Prien
(1965) study the largest percentage of reasons given for voluntary
turnover fell in the nature of work, supervision, human relations,
and lack of promotion categories. The Lyons (1970) study supported
a hypothesis that there was greater role clarity, more job satis
faction, less tension, and a lower turnover rate when adequate
WQrk related communication and better coordination eXisted.
Imparto (1972) found a high turnover rate associated rith low
scores on supervision and satisfaction with co-workers. McCloskey
(1974, 1975) found that psychological rewards were most L~portant
in keeping nurses on the job. Those psychological rewards were
o~~ortunities to attend educational progr~~s, opcortunities to
eonti;,.ue course · .. lork, career adva."1cement other than to the head
12
nurse position, and recognition of work frem peers and supervisors.
An interesting finding of McCloskey·s study was that 69~ of
the staff nurses who left jobs reported that they could have been
influenced to remain. Those who left for a promotion, to try other
areas of nursing, or to obtain increased fringe benefits said they
definitely could have been influenced to remain. The most sur
prising finding was that these who left because of pregnancy,
travel, to return to school, f.or personal and family reasons, or
because of It job dissatisfaction'· reported that they might have been
induced to remain on the job had t~ey been offered more rewards.
These findings cast doubt upon the usual grouping of reasons for
termination into voluntary and unavoidable or nonvol~~tary cate
gories. Perhaps some of ~~e terminations that are occuring for
'-unavoidable reasons I. can be prevented.
McCloskey's study also found that nurses experience a rise in
self-esteem after they quit their jobs. L~is was ascertained by
having nurses who had terminated their jobs complete two tan-item
Semantic Differential indexes headed by the COnC8?t of "Me in ~ly
Last Nursing Job'· and "Me in My Current Posi tion." XcCloskey
speculated that poor interpersonal relationships are often respon
sible for an individual's low level of self-esteem on the job.
The reasons nurses list for ~erminating a job indicate ways to
decrease the nursing turnover and dropout rate because those
reasons reflect areas in r"llich nu~ses &re not being motivated.
Previously cited studies demonstrate that nursas feel their jobs
:nc!'e deficient in provid:'ng social and psychological re·~ards than
in meeting their salary and working hours needs. >!ethods to
satisfy these needs eQuId. significantly reduce the turnover and
~ropOut rate in the nursing profession.
13
Many nursing researchers and t~eorists are attempting to define
more basic reasons behind the dissatisfaction in nursing other than
the simple explanations given for terminating a job. Role con
fusion and role conflict are the primary areas under investigation.
Corwin, Taves, and Haas (1961) feel that nursing students do
not bring realistic impressions of nursing to their jobs and there
fore develop reduced job satisfaction and show reduced job favor
ableness toward nursin~. Schools of nursing define them as pro
fessionals, but hospital bureaucracies define them as employees.
Thus a professional and bureaucratic conflict results which affects
~~e nurse's identity.
Benne and Bennis's study (1959) on role confusion and conflict
in nursing found that a nurse's role is determined by several sets
of expectations. These expectations include those presented by the
institution, her colleagues at work, reference groups outside the
immediate work group, and her own self-expectations. ~hen these
four sets of expectaticns contradict one another, role conflict
results. 'Nben they are consistent and reinforce each other, the
role definition is stable and motivation and job satisfaction are
high. In a nurse~ role there are ~any discre?ancies between the
ideal and the actual expectations of a nurse that promote role
conflict, such as the differing images nurses and doctors hold
re?ardin~ the ~ppropriate functions of nu~ses. Frustration results
14
when the ideal expectations cannot be attained. Tne continuing and
accelerated changes in the health field have probably contributed
tO~5e role conflicts and confusions. Benne and Bennis theorized
that there are three patte~ of adjustment to these conflicts.
Nurses either develop low motivation for work, rationalize away
part of the conflicting demands, or organize to ~esist the demands.
Since the Benne and Bennis study, Marlene r~amer has written
on nursing' s role confusion and what she terms "role deprivation. It
She defines role deprivation as tithe reported discrepancy between
the nurse's role as it should be and as it actually is found to
bett (Kramer, 19698., po 1903). In 1966 a survey of 45 new gra.duates
upon graduation and after three months of employment found that 44%
of the nurses expressed a fear of remaining in hospital nursing~
Specifically. many of those nurses surveyed did not like the rigid
hospital routines and found the work stifling, uncreative, and
confining. They wanted more autonomy to make judgments and deci
sions, to be able to use their knowledge and skills, and to be
evaluated by ~r professional colleagues (Kramer. 1966, po 242C)o
In 1969 Kramer again surveyed the nurses two years afte~ graduation
and found a significant decrease intheir professional role concep
tion or their beliefs and values about their professional role
( Kr amer t 1969a).
Kramer theorizes that the role deprivation in nursing is ca.used
by the conflict between the professional role concept of nurses and
the bureaucratic role concept necessitated by hospital employment.
A person with a high bureaucratic role conce~tion is loyal to a
15
bureaucratic system with its well-defined chain of command, its
system of rules and procedures, its division of labor based on
specialization, its promotion practices based on technical compe
tencies, and its impersonality of human relations. Baccalaureate
educational systems teach nurses a professional role conception
based on autonomy from organizational control, responsibility for
completing their job, self-evaluation, colleague relationships with
others, and freedom of movement from one position to another to
utilize professional behavior (Kramer, 1969b~. 'Nben a nurse taught
the professional role concept enters the bureaucratic setting of
most hospitals and faces the bureaucratic role concept, role depri
vation ensues.
Upon employment, baccalaureate graduates, with strong profes
sional role conceptions, must adopt bureaucratic role conceptions
due to environmental pressure. If they attempt to also retain
their orofessional values much discomfort ensues and there is a 5~
chance that they will leave nursing after trying several jobs
(Kramer & Baker. 1971, p. 26).
r~amer found that collegiate nurses experienced more job satis
faction and less role deprivation when their work situations did
not bind them down with rules and regulations but instead allowed
them to make individualized patient care decisions. A positive
relationship was found between minimal nurse role deprivation and
the presence of innovative ~ccalaureate nurse roles, the presence
of dual prOMotion ladders, the pre~ence of clinical nurse special
ists, and a decentralized decision-making structure (Kramer. 1969b).
16
All the answers about role co~jlict and confusion in nursing
have yet to be fully determined. The complete effect on nursin~ is
not well known. However, the studies that have been done indicate
there is a definite problem in nursing with role conflict and
confusion. The Kramer studies alone demonstrate role deprivation
contributes to turnover and dropout rates. Any serious attempt to
increase motivation and job satisfaction in nursing MUst take this
into account.
Another great conflict in nursing appears to be the amount of
time nurses can spend at the patient's bedside. According to
Hughes (1958). a wish to help others is a co~~~on reason given for
entering nursing. Benne and Bennis (1959) found in their study
that nurses would most miss the relationships with patients if they
did not continue working. Yet, Lysaught (1971) found that only 4~ .
of a staff nurse's time can be used for direct patient care and half
of that time is spent passing medications. An RN actually spends
less tL~e in direct patient care than the LPN, aide, or nursing
student. The system of giving care in ~ost hospitals today does not
allow a nurse to really function in a manner that can satisfy one of
her most L~portant reasons for being a nurse.
Another topic that has received much attention in the litera
ture is the relationship between job satisfaction and productivity~
The popular opinion is that the satisfied worker is mere productive.
Haw~vert very few well controlled studies clearly support this.
Brayfield and Crockett (1955) conducted a detailed review of
the research done on employeets attitudes and e~plcyee performance
17
up to 1955. They found little evidence that ~n employee's attitude
has an appreci~ble rel~tionship to his work performance. They did,
however, find data suggestive that ~ttitudes may be related to
withdrawal from ~ job. In explaining the findings that were so
contrary to popular opinion, Brayfield and Crockett proposed that
researchers have tried to define the motivaticnal structure of
workers too simplistically overlooking individual differences in
motivations and perceptions. They suggested that researchers study
separately the causes, correlations, and consequences of satisfac
tion and the effects of different management philosophies upon the
attitudes and performances of employees with different Motives,
aspirations, and ex~ectations.
In 1970 Schwab and Cummings also reviewed ~ literature on
theories of performance and satisfaction. They concluded that
research to date had not accounted for enough variables which could
influence the strength and perhaps even the direction of the rela
tionship between satisfaction and performance. The relationship
between job satisfaction and productivity is therefore still unclear
due to its complex nature.
Today nursing is facing a very complicated problem. As stated
earlier t employees are be~inning to demand that work help satisfy
many of their needs. Health care costs are spiraling at a dramatic
rate. Consumers are demanding high quality but economical health
care. Hospitals are having to find methods to L~prove the effi
ciency of utilization of their health care provicers. The nursing
profession; at a time when it needs to be giving care that is even
18
more efficient and of higher quality. is faced with a high turnover
rate. a high ~ropout rate, malcontent, work alienation, role Con
flict, deprivation, and confusion. Therefore. the need for re
searching and improving motivation and job satisfaction in nursing
is essential.
As stated earlier, the purpose of this particular study was to
improve the motivation level of a group of nursing personnel in a
work situation. It is difficult to objectively measure a person's
level of motivation. However instead, specific outcomes resulting
from a changed level of motivation can be measured. As indicated
in the literature review, a low level of job satisfaction and the
resultant high dropout and turnover rates are s~ecific outcomes of
the motivational problem in nursing. Consequently increaling the
measured level of job satisfaction and decreasing the turnover rate
were the specific objectives of this research problem.
A method of measuring employee turnover rate is subject to
debate in the literature. It is generally agreed that the turnover
rate equals the totel number of terminations divided by the total
number of employees (Dane, 1972; Dodge, 1960i & Tuchi & Carr, 19?1~
The debate revolves around what to include in the total number of
terminations. Some authors do not include nonvoluntary or unav·oid
able turnover in that number as they feel management can do nothing
to reduce that part of the turnover rate; in fact, it may ~e
beneficial to a co~pany as it prevents stagnati0n and because
startin~ salaries are lower it saves the company money_ ether
aut~ors include every termination in t~e total number no matter
19
what the reason.
For the purpose of this .~tudy turnover rate included all a.ctual
terminations and transfers from the unit regardless of the reasono
This was decided because of the doubt cast upon the usual grouping
of reasons into voluntary or nonvoluntary categories (McCloskey,
1974, 1975).
Although job satisfa.ction is a very complex attitude to
measure, several means of measuring job satisfaction have been
tried. There are tests that claim to give an indication of overall
job satisfaction and others that indicate specific problem areas.
Part of the difficulty in measuring job satisfaction lies in our
actual understanding of just what it includes. There is no widely
accepted definition nor even a common understanding of the basis of
job satisfaction. Therefore, researchers must select an already
devised measure or create their own based upon what they wish to
measure"
The measure used in this study was a tool devised by
Dr. Frederick Herzberg to measure the success of some of his job
e~xichment programs (see AppendLx a). lne use of this auestion
naire was necessary as the motivational methods 'lsed in this study
were based upon Herzberg's Theory of Hotivationo This theory does
not support a measure of overall job satisfaction since it is based
upon the existence of two separate factors--job satisfaction and
job dissatisfaction. To be in line with Herzber~fs Theory~ ~n
overall look at .iob attitudes must measure job satisfaction and
job dissatisfaction separately as ·~1.11 be ex~lained in greater
20
detail in the next chapter.
Herzber~'s tool measures ~hether or ~ot an e~ployee feels that
his job has provided him -,..ri th th058 factors defined by Herzberg as
necessary to promote job satisfaction. No other m.easure of job
satisfaction ~o(not.m to the author tests job satisfa.ction and job
dissatisfaction as two separate attitudes. All other tests are
based upon the theory that job jissatisfaction is the opnosite of
job satisfaction and thus give an overall job satisfaction score
that reflects an employee's position on that continuum. DeviSing a
test to measure the success of attempts to install Herzberg's
motivational methods was beyond the scope of this study.
Another area of concern was the possibility of measuring per
formance results. Many researchers attempt to measure the effect
of changes in a ~er50n's level of motivation upon his performance
or productivity levels. This study did not attempt to measure the
nursing performance ch3ngss o This was decided for two reasons.
The most important reason was because of the nebulous relationship
between motivation and performance. As explained earlier, to date,
few well controlled studies support the popular opinion that the
satisfied worker is more productive. The second reason why an
attempt to measure changes in the subject's nursing performance was
not made was due to the great difficulty involved in measuring that
performance. Nursing is not an exact science. It involves many
skills. such as therapeutic behavioral techniQues, for which a
satisfactory method of measurement has not been developed.
Instead of measuring total nursing performance, other indica-
21
tors of the level of motivation were measured. As explai~ed
earlier, the liter~ture review revealed that the turnover rate and
the level of job satisfaction are strong indicators of motivational
problems in nursing. If those indicators change then it can be
assumed that the level of motivation changed.
The turnover rate is a simple measure to calculate; howeyer.
job satisfaction is more complex. Determining the level of job
satisfaction necessitated assessing many components of that attitud~
This was accomplished by the use of Herzberg's questionnaire. It
asked if any changes in work had been noticed; specifically, if
there was an increase or decrease in recognition, achievement,
work itself, responsibility, advancement, and srowth. Each person
was asked how they felt about the changes and if, because of the
changes, there was an increase or decrease in the amount of satis
faction attained from work. Finally, a rating was made of how
strongly nositive and negative feelings were affected by the
changes. A second tool used to assess components of job satis
faction asked each person to rate 12 factors Herzberg identified as
contributing to job satisfaction and job dissatisfaction in order
of priority for an ideal job (see AppendiX C). Collectively then
these two tools gave indications of chan~es in the level of job
satisfaction. Combined with the turnover rate measures, changes
in the level of motivation was determined.
CHAPT.sR J
CONG EPTUAL F:1.ANEtiORK AND HETHOr.:oLOGY
Motivation Theory
Motiv~tion is a po9ular term. Volumes have been written on
~otivation and it is a word that can be heard aL~ost daily. So
called "axperts" are easy to find. There are many personnel prac
tices in use, such as the shorter work week, higher wages, better
fringe benefits, strivings for better commu~ication, and sensitiv
ity training, which attempt to ~otivate~ the ~o~ker. Caution must
be exercised when seeking ~n ll..""lderstandlng of motivation to differ
entiate between that which is based on tested, accepted theories
of ~otivation and that which is based on popular opinion atout mo
ti vation 'i-Ii thout any supporting research. erver the years, a. docu.
mented 1.L"r'lderstanding of the basis of motivation has increased.
One of the earliest theories on how to motivate workers came
from Frederick Taylor (1911). He felt that men i,zere motivated by
money. He supported an incentive system ',.;hereby the m.or9 an ambi
tious worker produced the ~ore he earned. Taylor argued that if a
highly productive worker ea~ed the same as a lazy ~orker the
highly productive worker r..;ould loose incenti va to produce at his
maximu.'1l.
It ~ust be remembered that when this theory ~as popular ~oney
23
had a different connotation than it does today. Pay to many
peo91e~eant a mea..'1S for obtaining the basic neces3i ties in life.
With extra hard wor~ and saving they ho?ed to be able to earn some
of the luxuries in life. Money, or the lack of it, was a strong
motiv~tor. Today it is not the same motivator as it once Nas.
Many people now take the basic necessities and even many of the
luxuries in life for granted feeling that it is only a matter of
justice and equality that they have them. ~~st peo~le expect to
obtain luxuries early in their working careers. Therefore, money
does not Motivate in the same manner as it once did since it no
longer means basic survival to many people (Gelle!'!Tlan, 1971).
The Hawthorne Studies were the next major step in motivational
theory. These studies lasted over 15 years at the Hawthorne Works
of ta.'1e t,";estern Electric Company in Chicago. The first studies de
monstrated that employee attitudes can counteract the effects of
poor environmental working concitions. Later, the role of super
visory ?ractices in influencing employee attitudes was recognized.
This research precipitdted the ''human-rela.tions·· movemar:t in man
agement (Anastasi, 1964).
A. H. Maslow (1943) developed a theory of motivation that
sho~'1ed man to be motivated by different needs at different times.
He proposed a hierarchy of five levels of needs. The most basic
he called the physiological needs. These are h~~ger, thirst, sleep,
activity, and sex. He felt it impossible to list all of the f~~~da
mental physiological r~Guiremer.ts ~an can have. L~e second level
are the safety needs. These are characterized by man seeki~g
safety, security, and organ~zation in his world. In fact, :~slow
felt that man's i!1terest in science, philosophy, and religion is
stimulated by t~is need. The third level is the need for lava.
This includes :nan's need for love, affection, and belonging. Tne
fourth level are the esteem needs. This means that man desires a
stable, high evaluation of himself, self-respect, self-esteem, and
the esteem of others. The last level is self-actualization. This
is man's desire for self-fulfillment or to become actualized in
what he has the potential to become.
Maslow characterized the levels of needs as prepotent. This
means that man will be motivated by the most basic need that is not
satisfied. This xiII monopolize his consciousness and will tend to
organize and move his various capacities into action to meet that
need. For example, if a man was lacking food, safety, love,
esteem, and actualization he would desire food more strongly than
any of the other things. Once he had enough food he would desire
safety since his need for food is now nonexistent. Thus, ~an is
motivated only by unsatisfied neecs and his behavior becomes organ
ized towards thair satisfaction. Gratification of a need is im
portant, though, in that it releases man from its domination and
allows him to move tOl-1ards attaining higher level goals.
~~slow's hierarchy of needs is not to be taken in a step-wise,
all-or-none relationship to each other. ~~st people are partially
satisfied and partially ~~satisfied in all their basic needs at the
same time. ~~e percent of satisfacti~n :or a normal person prob
ably has a decreasing percent as one ascends the hierarchy. After
the satisfaction of a prepote~t need, the emergence of a new need
is gradual, not sudden. Also ~ost behavior is multi-motivated; it
is determined by several or all of the basic needs simultaneously.
Maslow also recognized that there are many determinants of behavior
other than the gratification of basic needs. He characterized man
as a perpetually wanting animal. If a person is blocked from sat-
isfying a basic need he sees it a psychological threat which can
lead to frustration.
~~slow's theory of motivation initiated in-depth analysis of
individual's need hierarchies. Chris Argyris (1957) developed a
theory of motivation based on the needs of Doth the formal struc-
ture of the organization and of the individual. He was concerned
about the relationship between the two and their mutual impact upon
each other. He discovered some basic incongruencies between the
requirements of a formal organization and the growth trend of a
healthy personality in our culture. The result of this conflict
will be f~~strationt failure, short-time perspective, and conflict.
The subordinates of an organization will experience competition,
rivalry, insubordinate hostility, and concern about the par~s
rather than the whole. The result of all of this will be that the
in~ividual will undertake some defensive acts that will be destruc-
tive to the organization. Argyris felt the solution would be to
reduce the degree of dependency, subordination, and submissiveness
experienced ty e~9Ioyees. He felt job enlargement a~d e~plcyee-
centered, democratic, or participative leadership were specific
ways of acco~plishing this.
26
The two terms ;ob enrichment and job enlargement are fre-
quently used interchangeably ~n the literature. For the purpose
of this study, job enrichment will me~~ rehabilitating jobs or
giving peo~le better or more meaningful work to do. Job enlarge
ment will mean practices aimed at giving employees more work to do
rNithout changing the meaning of that work (Herzberg, 1976, p.95).
Douglas McGregor (1960) developed a theory of motivation
called Theory X and Theory Y. Theory X management practices are
based on the belief that people dislike work and will avoid it.
Management, accordi~g to this theory, must direct, control, coerce,
and threaten its employees to gain results. McGregor maintains
that people who dislike work do so because of the above mentioned
management practices. Theory Y assumes that people like and enjoy
work ~~d that they are self-directed and seek responsibility. Thus
a Theory Y ma~ager 'Nill use job enlargement, decentralization,
positive incentives, and provide opportunities for personal growth.
McGregor believes that if TCeory Y management is used an indi\~d
ual's perforr.Ance can be stimulated to exceed the requirereents of
his job description.
Rensis Likert developed the participative ~anageMent theory
(1961). This theory supports the use of the human relations tools
to foster supportive relationships among all group ~embers, to
keep groups working as a unit. to keep the ~anager orien~ed toward
his employees, to facilitate group decisicn making, and :0 promote
t~~st and favor~cle attitudes between superiors and subordinates.
Y~nazement by objectives ~~d enrichment approaches a~e used
27
in partici?ative ~ana~ement.
The t}:eory used fer this stt:.dy, the '1::1ual factor theory" \o[as
develooed by Frederick ne!'zberg (1973, 1976). This th eory ~a.s
been widely ve~fied. By 1976 fifty repetitions of the original
study had been reported (Herzberg, 1976, p. 311). Nore than 17
different occupations had been studied involving a wide range of
skills, job levels, and types of organizations, inclucing workers
in Finnish and Hungarian industries (Herzberg, 1973).
Basic to his theory is Herzberg's belief that man has two
sets of needs: his need as a human being to grow psychologically
and his need as an animal to avoid pain. He developed his theory
from a study he conducted of two hundred engineers and accoQ~tants.
In interviews ~~ey were asked about events at work they had exper
ienced that resulted in either marked improvement or marked re
duction in job satisfaction for them, and they were asked to give
a sequence of events that resulted in negative and positive feel-
in~s about their jobs.
From this study and subsequent others, Herzberg discovered
that workers identified totally different events as being associ
ated with positive feelings about thei~ job or job satisfaction
than they identified as being associated \lith negati""e feelings or
job dissatisfaction. The factors associated w~th job dissatis
faction rarely appeared in the events :~e subjects described for
job sa.tisfaction. Conversly, the factors associated with job
satisfaction rarely appeared in the events the subjects described
for job dissatisfa.ction. Therefore, Herzbsrg deter:nined that job
23
satisfaction and job dissatis:acti~n are two saoarate, u~ique atti
tudes. Job satisfacti~n and job dissatisfacticn are net on the
same continuum; instead, they are separate unipolar concep~s. A
person can experience high or low job satisfac~ion and high or lew
job dissatisfaction at the same time.
The factors that Herzberg has found to be strong detarmin~~ts
of job satis:8cticn he term.ed motivator factors. Those factors are
achievement, recognition, work itself, responsibility, advancement,
and possibility of grcwth. These factors describe man's relation
ship to ~hat he does in his job. Herzberg asked subjects of the
studies to interpret the events they described and tall why they
led ,to a change in their feelings. The results showed that ~otiva
tor events led to job satisfaction because of mants need for
growth; or as Herzberg believes, one of man's set of needs is to
grow psychologically.
The factors found to be stror.~ determinants of job dissatis
faction, Serzberg termed hygiene factors. Those factors are com
pany policy and administration, supervision, salary, interpersonal
relations, working ccncitions, status, job security, and effect on
personal life. The hygiene factors describe mants relationship to
the context or environment L~ which he does his job. wben subjects
were asked to interpret hygiene factors it was found that they led
to job dissatisfaction because of a need to avoid wipleasantness;
or as Herzberg believes, man's second set of needs is as an animal
tc avoid pain.
The i~portant tting :or ~~na~e~ent to understand from this
29
theory is tt_st "the two sets of factors (hygiene and !!1ctivator)
are unipolar, i.e. separate and distinct from each other. The op-
posite of job satisfaction is no job satisfaction, not job dissat-
isfaction. Likewise, the opposite of job dissatisfaction is no job
dissatisfaction, not job satisfaction. However, Herzberg does be
lieve that there are some individuals who do receive job satisfac
tion soley from hy~iene factors. This is because they have not
reached the stage of personality develo~~ent at which self-actual
izing needs are active or because of their past experiences they
have learned to react positively to hygiene factors as satisfiers.
Herzberg believes that the lack of motivators in a job in
creases the employee's sensitivity to real or i~agined poor job
hygiene nractices. The amount and ~uality of job hygiene !Ylust be
constantly improved as the relief from job dissatisfaction is only
temporary. Hygiene factors are short range whereas motivator fac-
tors are long range.
Herzberg believes that motivated oerform.ance ~..rill result when
motivators are combined with good hygiene practices. He has insti
tuted practical apolications of his ~~eory in industry through the
utilization of "Orthodox Job Enrich~ent.1t This ba~ically calls for
installing motivator factors into a person's job. Exactly how this
is done varies ~~th each unique situation. Herzberg believes that
the following factors are essential to orthodox job enrichment:
direct feedback, a cli~nt to employee relationship, a learning func-
tio~, the opportu~ity ~or each person to schedule ~~s o~~ wor~,
unique expertise, cont~ol over resources, direct ~ommu~ication, and
30
personal aoco~tability (Herzb~rg, 1974 ).
The result of orthodox job enrichment, as demonstr~ted five
studies carried out at L~perial Che~~cal Industries Limited, was an
increase in performance. In all of the studies there were in-
creases in parfor'manca and some of those increases were spectacular.
However, this is expected in orthodox job enrichment as satisfac-
tion is believed to be the result of performance, not the cause.
Attitudes do not change quickly and w~th many jobs there is much
frustration to overcome and forget. In those studies, the largest
gains in job satisfaction came after the longest job enricr~ent
trial periods (Paul, Robertson, and Herzberg, 1969).
Although considerable research has been done on motivation and
job satisfaction, very little has been done in the nursing profes-
sion. There are many articles in the nursing literature expressing
opinions about motivation or saying that motivation is needed, but ...
there is verJ little actual research. Most of what there is has
been done only in recent years. There are four studies in which
the researchers surveyed nurses to discover what they perceived as
important determinants of job satisfaction. In reading the results
of these it is interesting to note the most imuortant ~actors in
each study, but the value of this information is questionable as
there is no general agreement between studies.
Marlow (1966) surveyed 200 nurses in Pennsylvania and deter-
mined that the following factors determined e~ployee needs in order
1- good working conditions 2- ~ork that keeps you interested J- jeD :S8c:.lrity 4_ good wa~es 5- full aporeciation of work done 6- tactfui'discipline 7- personal loyalty to workers 8- promotion and grow~h in the hospital 9- feeling "inft on things
10- sympathetic help on personal problems
31
Slocum, Susman, and Sheridan (1972) in a study of need satis-
faction and job performance among professional and paraprofessional
hospital personnel compared performance scores T~th satisfaction
scores for each group. They found ~~at differences did exist in
satisfaction of basic needs between the two groups. It was inter-
~sting that for the profeSSional personnel satisfaction of self-
actualization needs was related to job per.fo~Ance.
Everly and Falcione surveyed 144 staff RNs in four east coast
metropolitan hospitals to discover the determL~~~ts of their job
satisfaction. The ~ost i~oortant factor was interpersonal rela-
tionshi?s T~th co-workers, their immediate super/isor, and zaneral
supervisory personnel. The second factor was intrinsic satisfac-
tion gained from the work itself through ~~e development and use of
new skills and abilities. The third factor was opportunities for
advancement, pay, and employee benefits. Finally, the last deter-
minant of job satisfaction was administrative policies (Everly and
Falcione, 1976).
Benton ~~d wbite (1972) surveyed 565 ~~s to obtain their reac-
tions to 16 job satisfacticn factors. The nurses ~anked the factors
in :he ~ollowing order of importance:
1- patient care 2- adequate personnel per shift J- congenial work associates 4- job security 5- authority and responsibility to do job 6- physical working conditions 7- basic salary 8- written personnel policies 9- appropriateness of hours worked
10- inservice training programs 11- pay differential for experience 12- management recognition of nurses' personnel unit 13- appreciation by patients 14- written job descriptions 15- pay differential for education 16- promotion opportunities
When these factors were divided into Maslow's need hierarchy,
32
Benton and wbite dete~ned that safety and security were the most
important followed by social, esteem, and self-actualization
factors.
A few researchers have looked at job satisfaction in nursing
in light of the Herzberg Theory. Longest (1974) investigated job
satisfaction among nursing supervisors in ten Atlanta hospitals by
determining the effect of Herzberg's ten factors of achievement,
recognition, work itself, responsibility, advancement, policy and
administration, technical supervision, working conditions, inter-
personal relations, and salary en job satisfaction. 'TI~e nurses
were asked to rate, in te~s of perceived importance, the effect of
the factors on their job satisfaction level. The following ranking
was obtained:
1- achiev":'!T!.ent 2- interpersonal relations 3- ',..-ork i tsel! 4- policy and adMinistration 5- responsibility 6- supe~ision-tecr~~ical
7- salary 8- working conditions 9- recognition
10- advancement
33
TNhite and Ma~uire (1973) surveyed nursing supervisors in six
Philadelphia hospitals to determine if the Herzberg theory was
applicable to them. The nurses were asked to describe times during
their employment when they felt job satisfaction and ti~es when
they felt job dissatisfaction. The method of t~e study and the
method of analyzing the data essentially duplicated ~he methods
used by Herzberg. Tne list of job satisiiers and job dissatisfiers,
as described by the nursing superrisors ~as similar to those lists
discovered in the Herzberg studies. Work itself, achievement.
recognition, responsibility, growth and advancement were found to
contribute to job satisfaction. Supervision, hospital policy,
working conditions, interpersonal relations, salary, and personal
life contributed to job dissatisfaction. TI~e main difference be-
tween the Herzberg studies ~~d this one was that, inste~d of job
security and status, the nursing supervisors described a factor
called competenca-com~ittmant-contentment of allied personnel.
was classified as a ~ogienet. as it did not distinctly fall into
either the satisfier or the dissatisfier column. The nurses listed
as motivators in order of importance: work itself, achievement,
recognition, responsibility, growth, and advancement. The hygienes,
in order of i~po~t~~ce, ~ere supervision-technical, hospital policy,
work~~g conditions, interpersonal relations, s~larJ and perscnal
life.
J4
Dr. Frederick Anderson (Herzberg, 1973) studied 29 ?rofessional
nurses in a Veterans ~~inist~ation Hospital in Utah. ~e also ~sed
L~e Herzberg methods. He found the motivators to be recognition
and achievement and the hygienes to be company policy and adminis
tration, interpersonal relations with supervisors, and working
conditions. L~ the study the factors of recognition, achievement,
and .vorking conditions only approached statistical significance due
to the small n~~ber investigated and to problems in the interviewing
situation.
Furnese of 1h! Study
The purpose of this study was to improve the level of motiva
tion of a group of nursing personnel. As can be seen from the re
view of the literature on motivation, there are many similarities
between the theories and how they propose to increase the worker's
level of motivation.
The theory selected for this study was Herzberg's Dual Factor
Theory. The fact that it has been ,,.ridely tested was an important
consideration deteMlining it-s choice. Also, 3:erzberg goes one step
further than oL~er ~~eorists and gives specific ways to implement
his theory on a practical level with his orthodox job enric~~ent
plan. Studies of companies who have i;Tr~lemented Herzberg's ortho-
dox job enrichment prog:r-aIn have demo!1~tra.ted positive results
(Herzberg, 1968; Herzberg and Rafalko, 1975; Paul et al., 1969).
However, the decidin~ factor for choosing Herzberg's t~eory Nas
how ~ell it indicated solutions to many of ~he o~oblems demcnstated
35
in the review of the !1ursir..2: literature. TI'le stuciies or. :.rhy nurses
ter~inat9 a job indicate t~at t~ey ¥ant mo~e social and ~sycholog
ieal rel~Tards; snecifically, they ·..ra:!1.t ir'lproved communications, role
defini tion, sUpervision, rela tionships ~tli th co-v-;ortcers, opportuni
ties to use ~~eir experience and ability, ongoing education, clin
ical advancement, and recognition. Satisfying these social and
psychological needs could reduce some of the role confusion and
conflict in nursing. Herzberg's Dual Factor Theory provides for
the satisfaction of many of these needs via his six motivators of
achievement, growth, recognition, responsibility, advancement, and
~,o1ork i tsel!.
At the same time ~~at Herzberg's theory provides ways of in
creasing job satisfaction, it also considers the importance of pre
venting job dissatisfaction by providing hygiene factors.
Herzberg's hygiene factors are company policy and administration,
supervision, salary, interpersonal relations, working conditions,
status, job security, and effect on personal life. As seen in the
studies on termination, these hygiene measures were of concern to
nurses although generally not as great as the motivator factors.
A final consideration in selecting Herzberg's theory was that
studies involving nurses have proven his theory apolicable to the
nursing profession. Also, other nursing studies tnat attempted to
define im?Qrtar.t job satis:action factors pointed to many of the
factors delineated by He~zberg.
Hospital n1J.rsing is a unique field in which to implem.ent
orthodox job enrichmer.t. L~ tte hospital situation r.ursi~g is
36
controlled not only by tte nursing a~ministration of that hospital
but also by the doc!crs, by the hospital adm~nistraticn w~ich i~
eludes the beard of trustees t by several federal a€e~cies 3.:-,d re
quirements such as Joint Comr~ssion on Accreditation of Hospitals,
by local and state a~encies such as the licensing boards, and by
professional nursing organizations. In addition, hospital nurses
must work closely with and depend upon ~any other departments and
orofessions. Radically redesigning the nursing positions on one
unit in a manner ~~at could provide the ultimate in orthodox job
enrichment was beyond the scope of this study since that would have
required extensive remodeling of the study un1 t as well as rede
fining and changing many of the roles and d~tias of several support
L~g depar~~ents in ~~e hospital. Inste~d, the attempt of this
study was to provide orthocox job enrichment in the existing struc
ture and system of the hospital and nursing department. Total
budgeted staffing positions, phYSical layout of the unit, job de
scriptions, and responsibilities and fa~ctions of other departments
could not be changed.
Statement of Problem ~ Hypothesis
The problem to be solved was how to increase the level of moti
vation of the JC nursing staff; specifically, how to increase the
level of job satisfacti n. The means to accomplish this was by
chang~ng the work environmer.t so that it was meeting their needs.
A change in the turnover rate was one measure of whetc.er or not the
job satisfaction level was affected.
37
~..,o research hY'potheses ';iere tested. The first ~,,-as tr:at the
meas~red level of job satisfaction in a group of nurses will in-
crease if motivators are provided. The second was that the turn-
over rate in a group of nurses will decrease if motivators are prc-
vided. A secondary purpose of the study was to determine if the
nurse's work environment was actually changed so that it was meet-
ing their needs. This was determined by learning if some of those
practices tr.ought of as motivators are actually seen by a group of
nurse's as motivators.
Definition 2£ Terms
Job Satisfaction- a positive attituce in a worker towards his job
determined by aspects of his job.
Job Dissatisfaction- a negative attitude in a worker towards his
job determined by aspects of his job.
Motivation- f'Jnction of what ~~ individual is capable of doing; how
much of an individual's talents are permitted to come forth on the
job; 'ffThat is reinforced (Herzberg, 1976, p. 106).
Turnover R.a. ts: total nu.l7lber of tsrndnations and tra.."1sfers total nQmber of employees
Y~tivators- Herzberg's factors of achievement, recognition, work
itself, responsibility, grow~h, and adv~~cement.
Ry~ienes- Herzberg's factors of com~any policy and a~l7linistration,
supervision, interpersonal relationships, working conditicns,
salary, status, and security.
Orthodox Job .2l1richment- "the installation of motivator i'actors
into an inc.ividua1 f s job" (Herzberg, 1974, p. (1).
38
Noti va tor Activities
Activities consistan~ with Herzberg's Theory ~f Motivation and
Orthodox Job Enrichment were planned to improve the level of moti
vation in the 3C nursing staff. As explained earlier, Herzberg's
theory relates ~~at job satisfaction is determined by the presence
of motivator factors in a job. Those factors are achievement, rec
ognition, work itself t res~onsibilitYt advancement, ~~d the possi
bility of growth. These Motivators were provided by several
changes initiated on the unit. Many of these changes were prompted
by problems on the unit identified by the staff. The changes also
contained the eight ingredients Herzberg feels are necessary for
Orthodox Job Enrichment. Those ingredients are direct feedback, a
client-to-employee relationship, new learning, scheduling, unique
expertise, control over resources, direct co~~ications au~~ority,
and personal accoQ~tability (Herzberg, 1974). The activities ini
tiated for the purnose of increasing the level of job satisfaction
on 3C are detailed in the following paragraphs.
1. A staff committee was fo~ed to i~prove between shift re
port. The CO~T~ttee was given ~~e responsibility and authority by
the unit supervisor to plan the changes and implement them, which
it did. It was decided that only the team leaders and the medica
tion nurses would attend between shift report. This decision then
necessitated their development of a plan for a team leader to team
member report to occur after the between shift reFort. Finally,
the cc~~ittee developed specific ~uidelines for the content of the
t";oo1O reports.
39
2. Another staff committee was formed to develoD an improved
method of assigning patients to staff members. As ~dth the other
committee, they were given, by the unit supervisor, complete respon
sibility and authority to plan and implement the change. The meth
od of patient assignment they developed matched the skill level of
the nursing personnel to the care needs of the patients. The hope
was to move towards a type of total patient care whereby each staff
member cared only for patients for ;/;hich t.."ley could do comprehensive
care for each patient. The intent was to better utilize and chal
lenge ~~e staff. Previous to this, three or four staff members
were jnvolved in each patient's care.
Cl.asses to increase t..'1.e skill level and k:no~iledge of the aides
on JC" were provided monthly. Before the classes the aides were
functioning at a level far below their potential and job descrip
tion as determined by the L~vestigator and some of the RNa on the
unit. Many of the classes were taught by 3C RNs.
4. For the entire staff two inservices were provided everJ
month. One was a topic of common interest, such as arterial blood
gases, to challenge the staff. Another was provided to refresh
their skill levels. Some of these inservices ware presented by
unit personnel who expressed an interest in doing so and, as deter
mined 'oy the supervisor, had expertise a.nd. k.'r'lowledge to contribute.
S. ~very &~ on the unit was to hold a.t least one conference
Der T,.;eek ·,·n th her team members to plan patient care or to increase
the te~~ members· nursing and ~edical knowledge. These conferences
were uns~ructured and could be on any subject the team leader or
40
team members ~anted. The ultimate purpose ~as to increase commun
ication and Dlan~ing between team leaders and team memcers as well
as improve patient care. The success of the conferences was meas
ured by descriptive observations of the staff members and of :he
investigator.
6. A pre-operative patient teaching program was initiated for
general surgery patients. Several interested staff members were
involved in pl~~~ing this class. The class was tau~~t to patients
before surgery. The teaching was done by interested ~s from the
unit after they had been oriented to the content of the class and
to teaching methods. All of the RNs working ~~e 3-11 shift did
followup teaching with individual patients L~e night before surgery.
7. Team rounds were initiated to audit patient care and pro
vide positive feedback to the staff. The rounds consisted of the
supervisor or clinician and the team leader and team members making
ro~~ds on a team of patients at least once a week. The progress of
the 9atient, the plan of care, and staff teaching needs were speci
fic areas of concern. Immediate fe~dback on the nursing care being
given was provided by ~~e supervisor and the clinician.
8. A third staff co~~ttee developed a unit orientation pro
gram for new employees. A skill check off list, a duties and re
sponsibilities list, a content check off list, and a ~~it routine
schedule were developed for each level. These tools were then or
ganized into a plan that detailed fer the new employee and for the
person orienting ~~at new employee ~at was to be taught and in
what sequence. This was to eli~ina~e the inc~nsistent tj~e of ori-
41
entation that new employees had been receiving in the past.
9. A new approach was taken towards staff interFersonal prob-
lems that occured on the ~~it. The supervisor insisted that the
people having problems attempt to discuss their difficulties ~th
each other. Before the meeting the supervisor coached the involved
staff members about approaches, what to expect, and how to handle
antioipated problems. If necessary the supervisor was present when
the people met to mediate and clarify co~mtU1ications. :hese direct
person to person discussions were to encourage positive co~~unioa-
tion among ~~e staff, make each individual mora responsible for
solving problems, and stop ''back biting'· on the unit. Previously,
when interpersonal problems occurred the responsibility for solving
those problems was accepted by the supervisor without joint L~volv~
ment of ~~e staff members.
10. Whenever general unit problems became evident, t.~ese prob-
lems ware taken to the staff in general staff meetings. They were
given the responsibility to uroblem solve the situations and imple-
ment solutions.
11. Finally, every staff member was encoura~ed to ~~dertake
projects to improve the unit operations. Examples of some of these
projects were inservices presented to the staff, a "Medication of
the Week't poster tellin~ about commonly used drugs, RNs." teaching
the nurse aide skill classes, a bedside care pl~~, and a m&~ual on
how to fill out lab and Xray requisitions.
~ch activity ~as intended to provide at least one of Herzber~
motivator factors. .t Herzberg defines recognition as . . .
nJ .~ ~ t 1':; ry
~: L~ ~ j,k'I'; S\ y
some act
42
of recogni tion 0:'" the gerson spea k ln~ to us. The source could be
al.most a.nyone. • • ft (Herzberg, 1973, p. 213). stu! me::nbers could
experience recognition through indivicual projects, and the pre-op
teaching program. Specifically, the unit sU?ervisor acknowledged
co~~ttee membars and ~~e work they we~e accomplishing both on an
individual basis and during general staff meetings. During team
rounds the goal of the supervisor and the clinician was to provide
positive feedback to the team members. It was felt that during
te~~ conferences staff members making contributions would receive
recognition. Those people working on individual projects were en
couraged and their efforts praised publicly especially in general
staff meetings_ Finally, those individuals who participated in the
pre-op teaching program received special recognition from the unit
supervisor. In a more general sense, the unit supervisor also
encourage the entire staff to thank and give positive reinforcement
to one another.
Herzberg believes that achievement at work comes from "success
ful completion of a job, solutions to problems, vindication and
seeing the results of one's -Nork" Herzberg, 1973, :9_ 214). Activi
ties that allowed 3C staff members to achieve were their individual
projects, the pr~-op teaching program, committee ~ork, aide skill
classes, inservices, team conferences, team rounds, and by solving
unit problems. The ~~it supervisor provided advice or assistance
as necessary to insure that ~ach of the activities resulted in
achievement ~d not failure.
The possibility of gro·~h comes from I~ot only the likelihood
43
that the individual WOQld be able to move onHard ~nd upward within
his organization but also a situation in ~hich he is able to aci-
vance his own skills It (Herzberg, 1973, p.214). Thus growth
could be experienced in the pre-op teaching program, aide skill
classes, inservices, team conrerences, committee work, through the
method or solving interpersonal problems and through individual
projects.
Advancement or "an ac tual change in the person t s status or
posi ticn in the company" (Herzberg, 1973, p. 214) wa.s 1i.1Ui ted. The
only chance to advance on 3C 'Na.s by t..'1e promotion of an RN to the
charge nurse or assistant supervisor position and for an aide to
the unit clerk position. However, all staff members were encour
aged. to continue their education. The hospital provided a tuition
reimbursement program and the lL."1i t supervisor encourai2:ed students by
scheduling aro~"1d their class schedule.
Responsibility at Nark derives from a person ~eing given re
sponsibili ty for his Ol-m work or for the ~4ork of others or from
being given new responsibility" (Herzberg , 1973, p. 216). Responsi
bili ty was gain,sd from the pre-<Jp teaching program, commi ttee ·.-lork,
team conferences, team rounds, the L~terpersonal problem solving
method, solving unit problems, and through individual projects.
Specifically lNith ~~it ~roblems, staff interpersonal problems, ~~d
wi th the problems for ",.Ihieh CO:rLrni ttees ~era fermed, t..~e uni t super
visor char~ed the staff wi~~ the responsibility and authority to
devise and effect solutions. In the past the uni t supervisor "..rould
have solved the problems wi th only input from the staff. '!hose
44
staff members involved in the pre-op teaching rpogram were respon
sible for effective ~atient teaching. During te~ rounds the ~~it
supervisor and the clinician reinforce with team members what their
~es90nsibility in patient care was. Finally, most of the individ
ual projects centered around solving a problem identified by the
staff member so they were taking responsibility for correcting that
problem.
A person is gaining job satisfaction from work itself when
that person seas the 'factual doing of the job or the tasks of the
job as a source of good or bad feelings about itt. (Herzberg, 197),.
p. 217). It was felt that work itself would De greatly improved by
the successful completion of the o~~er factors.
Appendix A lists the motivators and the corresponding activi
ties initiated on JC. Not only can the activities be looked at in
light of the motivator factors they provided; but also in regard to
~ich of the ingredients necessary for Or~~odox Job E~ric~~ent Nas
contained in the activities. This correlation is also detailed in
Appendix A.
Orthodox Job ~ric~~ent specifies that direct feedback, a
client relations~ip, new learning, scheduling one's own work,
unique a~pertise, control over resources, direct communications,
authority, and personal accountability are necessary to ir.crease
job satisfaction. The activities initiated on JC provided these
specifics.
Jirect feedback ;.,ras~'iven by the super-visor an':' ":!!s clinician
during team rou~ds and team conferer.ces. It ~as also felt that by
45 moving towards the concept of comprehensive patient care as devised
by 'the assi~en t corrur..i ttee, 't.~e pa tien t t.Tocld provide grea. ter di-
rect feedback to the person caring for them. A client to employee
relationship was enhanced by ~~e comprehensive patient care method
of assi~ment. A learning function or the chance for individuals
to grow psycholo~cally was contained in the aide skill classes,
inservices, tea.rn conferences, team rounds, and incii vidual projects.
The concept of comprehensive patient care offered employees a
greater chance to schedule their own ~ork. It also encouraged
individuals to develop Q~ique expertise with certain types of pa
tients. In the true sense of providing employees 'With mini-budgets,
control could not be provided. HOT/rever rl t..'1 ccmprehensi ve patient
care each staff member ordered necessary supplies for his patient
and also ~ade needed referrals to o~'1er hospital departments and to
community agencies. Direct communications were enhanced with team
rounds, COMPrehensive patient care and the method of solving indi
vidual problems. Finally, t..'1e concept of personal accountability
was invol~led in commi ttee work, team conferences, pre-op teaching
program, team r~unds, individual problem solving method, solvi~g
unit problems, and in individual projects.
All of the motivator acti~lities ~N'ere entirely new to JC. 11lhile
every staff ~ember ~as not involved with all of the activities,
each person -;.ras involved ,:nth at lea.st one. The activities were
made av~ilable for staff members ~~at worked all three shifts. Ynis
~"as made easier by the fact that t!1e majori ty of ~~'3 stat': ciid not
work nermanent shifts, but instead rotated shifts. I~ is possible
46
that new staff members hired into the ~~it durin~ this time were
not exposed to as ~any ~otivators as the other staff members. The
mix of the nursing staff was consistent in that &~Sf LPNs and NAs
were on all three shifts.
Specifios on the availability of motivator activities to each
staff member varied with each activity. The cou~ttees were com
posed of four or five volunteers and met at a time convenient for
all the members. The aide skill classes and the inservices were
provided several times so that the staff could plan a convenient
time to attend according to their schedule. The team conferences
were held on all three shifts. :,.{i th the prs-op teaching program.
volunteer staff members could plan to teach the class t-Thile on duty
or be paid to teach it on their day off. Every &1 working the
evening shift wa.s expected to do followup teaching. Team rounds
were carried out during the day shift by t.'1e supervisor or clinicim
and by the charge nurse on the evening shift. Individual projects
could be completed on all three shifts. Finally, the problem
solving activities occurred as L~e problems became evident. For
unit problems, zeneral staff meetings were called to work on ~~e
problem.
While the intent of this study was to increase the level of
job satisfaotion throu~h the provision of motivator factors, it
must be remembe~ed that Herzberg's Theory o~ Motivation d0fines
another set of facto~s, called hygiene5, that contritute to job
dissatisf2.cticn. :-terzberg b-2lieves that motiva.ted perfor"T1ance -..nIl
resul t '",ten mati va tors are comcined ~",i th geod hy~iane practices.
In this stu~y the hygiene practices of the hospital and the unit
were not manipulate~: that is, no chan?es in hygiene were planned
as part of the study.
47
Some changes in hygiene did cccur during this period of time.
The nursing department was making an intensive effort to update
their policies; so, ~any revised and new policies were put L~to
effect. Since the 3C unit supervisor had been on the unit for the
previous year, the experimental unit was not affected by adjusting
to a new supervisor. However, it is acknowled~ed that due to the
nature of many of the motivators provided, the style of the unit
supervisor did have to undergo some change. A radical change in
the vacation and sick leave policy in the hospital did occur.
Finally, a cost of living raise was given to everyone during this
time.
Samnle
The experL~ental group of nursing staff in this study was all
of the P~s, LPNs, end Aides employed on a 42 bed general surgery
unit known as 3C. The control groups for this study were all of
the R~s, LPNs, and Aides on a urology and EENT surgical ur.it, a
GYN and OB unit, an intermediate care unit, and a psychiatric unit.
The urology and EE.'JT unit, the GYN and OB unit, and the inter
mediate c~re unit were selected to be in the control group since
these units cared for sur~ical patients. The urolog~ and ~~T lJnit
had the same physical layout as 3e, an e:jual nu~ber of beds, and
was composed of ear, eye, nose, throat, and urolo?y patients. The
48
GTI~ and OS unit included many ~)~ecological surgical ~atients. The
intermediate u~it cared fer patients ~hich required more nursing
care than those on 3e, such as car~iact intrathoracic, and intra
cranial sur~cal patients. The staff of t~e ~sychiatric ~~it was
used as a control group to obtain a comparison from a staff that
cared for an entirely different type of patient population.
Due to the author being employed in the hospital, the fact
that the study Nas part of a ~Aster's thesis was kept strictly con
fidential. The only people aware of the reason for ~~e study were
hospital and nursing administration in order to gain permission to
undertake the study and ~~e supervisors of the control units in
order to gain cermission to use their staff members in the control
group. THhen the study was completed post-study de-briefing of all
participants was provided and all questions of the subjects were
answered. This was necessary because due to the nature of the
study, prior informed consent could not be sought.
Measures
Finding an objective tool to measure the effects of the pro
posed chan~es proved difficult. Motivation-Hygiene Theory does not
support a ~easure of overall job satisfaction. ~~O separa~e factors
are involved: job satisfaction and job dissatisfaction. Any over
all evaluation of job attitudes must be measured twice--once to de
termine if the motivator needs have been met and once to det-ermine
if the hygiene needs have been met (Herzber~, 1976).
Since the aim of this study was to ~rovide motivators, a tool
was needed to determine if those motivators were indeed provided
or if the sta!~ saw the changes initiated as motivators. Herzberg
has designed an Interview Format for a Job Satisfaction Audit
which he graciously allowed the investigator to use in this study
(see Appendix E). This tool asks if the individual has noticed any
recent changes in his work, if there has been an increase or de
cre~se in the sL~ motiva:or factors, how the employee felt about
the changes, if there had been an increase in satisfaction, and if
the changes affected the employee personally. In addition, the
employee is asked to rate any changes in positive and negative
feelins;s.
Herzberq designed the tool for an oral interview situation.
However, for this study the tool was used as a written question
naire. The advantages of a written questionnaire include no inter
viewer interpretations or bias in recording ~~e responses and anon
ymity of the responses. Eecause the author was employed at the
hospital it was especially im~rta.nt to provide for anonymity.
Also written questionnaires require less time.
To dete~ine if the Job Satisfaction Audit could be ~ven in
a written form L~e qUestionnaire was given to three nurses without
any explanation as to the results it was intended to discover, just
as was done in ~~e study. The results were encouragin~. The nurses
who filled out the tests during the trial test of the ques~icnnaire
were able to ~swer each ~uestion aopropriately. After filling it
out, the nurses were asked to make comments acout the questionnaire
itself. 'The ccrmnen ts received and the completeness of the wn ttSf'l.
50
responses lad the investigator to conclude that the Job Satisfac-
tion Audit could elicit satisfac~ory data in the written farm.
Another tool was given called Your Ideal Jab (see Appendix C).
This tool developed by the University of Utah College of Business,
listed various factors, both moti va tors and hygienes, in a job.
The employee ranked the factors, which gave an understanding of
what nurses see as important in their job and also told if a person
was motivator or hygiene motivated.
The reliability and validity of the two measurement tools is
unknown. wnen considering the data obtained, this fact must be
~onsidered. In addition to the two questionnaires, a page of bio
graphical data was obtained (see Appendix D).
Finally, the turnover rate of the unit was measured both his
torically (1975 and 1976) and during the experimental period (Jan
uary 1977 to September 1977). All terminations and transfers from
the Q~it were included ~n the rate.
Collection of ~
A pretest was ~ven before any of the motivators were started.
The biographical questions, the Job Satisfaction Audit and Your
Ideal Job tests were given to the experimental and to the control
units· staff by a person not connected to the hospital and unknown
to the employees. They were told that this pe~son was doing a
study on problems in nursing for ?ublicati~n. P~rticipation in the
s~udy was encouraged but left strictly voluntary.
After 'the pretests "Y'le:-9 comDleted and returned, t.he Drocess
51
of introducing motivators to the expe~i~ental group began and con-
tinued for nine months. After nine ~cnths the Job Satisfaction
Audit and Your Ideal Job tools and the biographical data questions
were again given to the experimental and control units' staff.
The following return of questionnaires was obtained:
Pretest Posttest"" CONtROL Number ~eturned .1. Nu.111ber Returned ~
Psychiatric 4 27% 3 15% OB/GlN 4 14~ 0 0 Intermediate Ca.re .5 l6~ 9 29~ EENT/Urology 4 11% 2 6%
17 I4 EX PERIMSN TAL
)C 12. 55% 1§. 50~
33 32
The percentage of return was determined by dividing the n~~ber
of questionnaires returned by the number of staif members (FUIs, LPNs
and Aides) on the unit. However this is misleading and not an accu-
rate representation of the return as not every person on ~he staff
was contacted and asked to participate. The method of conta.cting
staff members for the pre and posttest on the control ~~its and for
the pretest on the experimental unit was to ~eet with staff members
during between shift report. This was repeated several times on
each unit. However due to differences in schedules not every staff
member was contacted by this method. For the pretest on the exper-
imental unit more attempts were made to contact every staff member
and they w,.;erl9 encouraged and reminded to return t.he questionna.ires.
The posttest on the experi~ental unit was given iu~ing a general
staff meeting and time ',.;as allowed fo r t!:em to complete it then.
CHAPTER 4
FINDINGS
Biographical ~
The biographical questionnaire yielded the following infor
mation which must be taken into consideration when interpreting
the acquired data. The experimental group consisted of ~5% RNa,
30% LPNs, and 25~ Aides. The control groups T~re composed of
57% RNS, 14% LPNs, and 29% Aides. In the experimental group the
typical RN had 5 to 10 years of experience, had been in the present
position less than one year, was bet~een 20 to 30 years of age, and
had obtained basic nursing education in either a hospital or was an
associate degree graduate. The typical RN in the control groups
had one to ten years of experience, had been in the present posi
tion less than one year, was over 30, and had a bachelor's degree
for basic nursing aducation. The LPNs and Aides in the experi
mental group had less than one year of experience, less than one
year in their present position, and were 20 to 30 years old. The
LPNs and Aides in the control group had one to two years of expe
rience, less than one year in their present ~ositiont and w~~e 20
to 30 years old.
Turnover ~
The turnover rate was ~Aasured during the nine month periods
53
of February to October of 1975. 19?~. and 1977. as well as the 12
month periods of January to Dece~ber of 1975 to 1976. The experi
~ental period bein~ February to October 1977. The turnover rate
,,,as determined by dividing the total number of employees on the unit
into t~e total number of terminations and transfers from the unit
during a specified period of time. One research hypothesis tested
by this study was that the turnover rate in a group of nurses would
decrease if motivators were provided. Table 1 gives the yearly and
the nine month turnover rate data. As can be seen, the turnover
rate Nas lower during the experimental period than it was during
the same nine month periods of the preceding two years.
To determine it the decrease in the turnover rate was signif
icant. the t test c~parision of means and the F test analysis of
variance (Young & Veldman, 1977. p. 315) T~re run on the average
monthly turnover rate for each period. The average monthly turn
over rate was determined by dividing the number of terminations
each month by the number of emnloyees to obtain the monthly turn
over rate. Then for a specified period of time, the monthly turn
over rates '\-{ere added together and divided by the number of months
in that period to yield the average monthly rate. Table 2 gives
the average monthly turnover rates and their standard deviations to
indicate degrees of variability. Again note that the rate was
lowest durin~ the experimental period.
Table 3 details the rasults of the t tests and the F tests
used to rletermine significance bet\~~en the turnover rates. The
statistical null hypot~esis tested was ~at there would be no
TABLE 1
Turnover Rate
Rate for Eeriod of Time 12 Month Period Jan 75- Dec 75 -88,( Jan 76- Dec 76 76% Feb 75- Oct 75 Feb 76- Oct 76 Feb 77- Oct 77 ** 5n •
* adjusted yearly = period turnover rate X 12 9
** experimental period
Rate for 9 Month Period
61% 5~ 43%
\.n f::"
TABlE 2
Average Monthly Turnover Rate
e . d Ti e Rate Standard Deviation Jan 75- Dec 75 7.2 4.79 Jan 76- Dec 76 6.4f; 3.162 Feb 75- Oct 75 6.7f:. 5.196 Feb 76- Oct 76 6.2~ 3.66 Feb 77- Oct 77 * 5.~ 3.606
• experimental period
\ft \ft
Average Monthly Turnover Rate
Pericx:! of Time or Mean Feb 77- Cct 77 5.~ Fe b __ zQ- Oct 26 6.2 Feb 77- Oct 77 5.~ Feb 25- Oct 2L ~~-Feb 7'1- Oct 77 5. Feb 76- Oct 76 6.~ ~~ 25=-..J)c.L2.5... 6.7% Feb 77- Oct 77 5.~ Jan 76- Dec 76 6.4% Jan 75- Dec 75 7.2%
* not significant
TABlE 3
Turnover Rate Test of Significanoe
Values of t t equals beyond .05 Significant F equals
.7141 2.12 NS .. .51
.7937 2.12 NS .625
.6083 2.06 NS .37
.866 2.04 NS .75
Values of F beyond .05
4.49
4.49
3.40
3.32
Signif-icant .
NS
NS
NS
NS
,--
\..n ()',.
57
difference in the turnover rate among the groups. The rBsults of
the tests ofsi~nificance demonstrate that, while the turnover
rate was lowest during the experimental period, the difference was
not enough to be significant. In all the comparisions the F test.
which is a comparision of variances, accepted the null hypothesis.
Therefore, it could not be concluded that there ~as a difference
in the turnover rate among the groups as there was no statistical
support that the means were different from one another. Likewise,
the t t~st also accepted the null hypothesis as there ~as no
evidence that the turnover rate was less than expected by chance.
The research hypothesis that the turnover rate in a group of
nurses would decrease if Motivators were provided was not supported.
Data ~ Job Satisfaction Audit I22l
When analyzing the information obtained from the job satis
faction audit tool it was discovered that most of the questions
were answered in a manner that allowed categorizing. The first
question consisted of two parts. The first part which asked if the
person had noticed any changes in their work over the last eight
months, obtained yes or no answers. In the second part, they
described changes that had taken place, specifically what their job
assignments '~re before and after the chan~es in terms of func
tional duties such as passing medications or team leading.
~uestion 2 asked if there had been an increase or decrease in re
cognition for achievements, op~ortunities to achieTe, work itself,
amount of responsibility, advancement, and growth. The answers to
this question allowed categorizing into either yes. there ~as an
increase, or no there was no increase. Question 3 asked how they
felt about the changes and ~hy they felt the ~ay they did. The
answers could be classified as either positive or negative feelings.
Cuestion 4 asked if because of the changes there had been an in-
crease or a decrease in the amount of satisfaction obtained frOM
work and the answers fell into either an increase or & decrease
category. Question 5 asked if the changes affected the individual
personally, specifically did it change their relations with people
in general or with family and did it affect their sleep, appetite,
digestion, or general health. The answer to this question could
be categorized as either yes or no. Finally, question 6 asked the
individual to ~ate on a scale of one to seven how strongly their
negatiTe feelings about their job were affected by the changes.
This allowed the calculation of a mean number for each.
Table 4 gives the mode responses for question one through five
and allows comparison of various groups. or prime interest was the
resnonses of the experimental unit. The)C staff did see that
changes in their job had occurred during the exnerimental period.
However, the control units' staff also saw job changes during that
same period of time. Likewise 3e, in the pretest covering the nine
Month period before the experiment began, reported job changes.
During the experimental period, JC did not see an increase in re-
cognition, achievement t or work itself and the control units did.
The 3C staff felt there was an increase in ac~ieveMent before the
Motiva.tors were introduced but not after. An incraase in respon-
sibili ty was seen by the 3C staff after the in":.rodllction of the
TABLE 4
Comparision of Job Satisfaction Audit Data Among Units •
I control control control units control units 3C 3C units units without inter. without inter.
Group ipretest iposttest pretest posttest unit pretest unit posttest .Number il!. Group 16 20 17 14 12 5
Changes in Job yes yes no yes no -Recogni tion no no yes yes yes yes Achievement yes no no yes no yes Work Itself no no no yes no yes Responsibility no yes no no no no Advancement no no no no no no Growth yes yes yes yes yes yes Fe"a About Changes pos. pos. pos. pos. pos. pas. J\mt. of Satisfaction inc. inc. inc. inc. inc. inc. Personal Affects yes yes yes yes yes yes Relations to
People/Family yes yes yes no yes no Affect on Health yes no yes no yes yes
*Answers noted are the mode response (see AppendiX E for complete derivation)
inter .. inter. unit unit Ea. J2~~!_~ _ 5-- 9 _
--,-~---
no yes yes yes yes yes no yes no no no no yes yes pos. pas. inc. inc. no yes
no no no no
V'\ '-D
motivators; whereas, the control units did not see an increase in
responsibility. None of the units saw an increase in acvancement
opportuni ty. A chance for growth T,yB.S consistently seen in all of
the groups tested. 30th 3C and the control units reported that
they felt positive about the changes they had identified and all
groups said their amount of satisfaction had increased. The 3C
staff said that the changes they identified personally affected
them and their relations to other neonle and family but did not
affect their health.
Table 5 compares the responses of the RNs, LPNs. and Aides on
the experimental unit. The LPNs saw an increase in recognition and
achievement, but the RNa and Aides did not. The RNs and LPNs felt
an increase in responsibility but the Aides did not. On the rest
of tl::e questionnaire, the three groups agreed. They saw no change
in work itself or advancement, did see an increase in growth oppor-
tunity, felt positive about the changes, and experienced an in-
creased amount of satisfaction.
During the experimental peried one of the control units, the
intermediate care unit, initiated a modified t~e of primary care
nursing. 3ecause of the nature of this type of nursing, primary
nursing is frequently mentioned in the literature as a strong way
to motivate nurses and increase their job satisfaction. To deter-
mine how the intermediate care unit's staff saw the chan~e to
primary nursing, their responses to the Job Satisfaction ~udit
Tool were se~arB.ted out and compared in Table~. C~~paring the
intermediate care unit's responses to 3e t s reSDcnses it can be seen
TABLE 5
3C Posttest If!
RNa (N=9) tPNs (N=6) Changes in Job yes yes Recognition no yes Achievement no yes Work Itself/Assign. no no Responsibility yes yes Advancement no no Growth yes yes Feeling About Change pOSe pOSe Amt. of Satisfaction ino. ino. Personal Affects yes yes Relations to
People/Family yes yes Affect on Health no no
-~---
*Answers noted are the mode response (see Appendix E for complete derivation
Aides (N=5) yes no no no no -yes pOSe
inc. yes
yes yes ------
U' I·..J
62
that they saw an increase in recognition, achievement, and work
itself where 3C did not. The 3C staff felt an increase in respon
sibility where the intermediate care unit's staff did not. Both
units saw no increase in advancement but did see an increase in
growth. Both units felt positive about the changes and identified
an increased amount of job satisfaction. It should be noted that
the responses of the inte~ediate care unit are identical to the
rest of the control units.
The last question ta be considered in the Jab .. Satisfaction
Audit Tool is question 6 which obtained a rating from one to seven
of how strongly an individual's positive and negative job feelings
were affected by the changes with one being no chan~e and seven
meaning a great deal of change. The response to this question
tested the research hypothesis that the measured level of job
satisfaction in a group of nurses w~uld increase if motivators were
provided. Table 6 gives the mean score for each feeling for the
various groups. The scores indicate that both the positive and the
negative mean score increased in the experL~ental gro~o's ?osttest
compared to the pretest. The experimental unit's positive and
negative feeling pretest scores were lower than the control units'
pretest; however, in the posttest the experimental unit's scores
were hir;her.
Because of the initiation of prL~ary nursing on the inter
mediate care unit, a comparison was m~de of the ex~erimental unit's
pcsttest scores to the posttest sco~es of the cont~ol units ex
cluding the intermediate ca~e unit. The experimental unit's
TABLE 6
Mean Score for Change in Positive and Negative Feelings
control control control units inter. 3C 3C units units without inter. unit
pretest posttest pretest posttest posttest pretest
Changes in Posltive Feelings 2.9 4.8 3.2 3.5 4.0 2.8
Changes in Negative Feelings 2.9 3.6 3.6 2.6 4.0 2.3
(see Appendix F for complete derivation)
inter. unit posttest
3.4
2.1
0'\....J
64
positive feeling score was hi~her and the negative feeling score
was lower. The experi~ental posttest scores ~~re higher than the
intermediate care unit's scores. The intermediate care unit's
scores 'Nere lower than the rest of the control units. Finally, a
comparison of the intermediate care unit's scores showed a higher
score in positive feelings and a lower score in negative feelings
in the posttest than in the pretest.
To determine if the differences in mean scores were signifi
cant the t test comparison of means and the F test analysis of
variance test were used. The statistical null hypothesis was that
the changes in the positive and negative feeling scores would be
the same in all the groups tested. Table 7 gives the results. The
only comparison that reached significance was when JCts pretest
pOSitive feeling mean score of 2.9 was compared to JC's posttest
positive feeling Mean score of 4.8. The statistical null hypothe
sis was rejected in this comparison both by the F test and by the
t test. Sat it could be concluded that the mean scores were
different from one another and that difference was greater than
that exuected by chance. Therefore, the research hypothesis that
the measured level of job satisfaction wculd increase if motivators
were provided was supported by the comparison of Je's pretest
positive feeling mean score to its posttest score. However in all
other comparisons. among the various groups, of the positive and
the negative feeling scores, the differences were not statistically
si~ni!icant. ~ereforet the statistical null hypct~esis that the
changes in the p~sitive and negative feeling scores would be the
Positi.ve Feeling
Grouo Test lMean Score 3C Fre 209 13G Post 4.8 )C Pre )C Post 3C Pre 2.9 Control Pre 3.2 3C Pre Control Pre 3C Post 4.8 Control Post 3.5 3C --Post Control Post )C Post 4.8 Inter 0 Post 3.4 3C Post ±!It er~. Po s t 3C Fost 4.8 Control without _lnt~!':. _ F'ost -- 4.,0 )C Post C ontr 01 wi thaut
Inter. Post Inter. Post 3.4 Control without
Inter. Post 4.0
TABLE 7
Positive and Negative Feeling Tests of Significance Negative Feeling Values of t Mean Score t egua1s beyond .05 Significant F equals
2.28 2.08 S 5.18
2.9 .8602 2.11 NS .71 .. 3.6
.4899 2 .. 0'li NS .24
2.9 .7071 2.11 NS .50 1.6
1.68 2.08 NS 2.84
3.6 1.23 2.11 NS 1.53 2.6
.4899 2.09 NS 2.40
3.6 .6083 2.13 NS 307 2.1 -
.4899 2.18 NS .24
3.6 .244 2.2) NS .06
4.0
.43.59 2.26 NS .19
Values of F beyond .05
4.32
4.45
4.30
4.45
4.32
4.45
4.38
4.54
4.75
4096
5.12
Signif-icant s
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS 0-
\J'I
Positive Negative rt'eeling Feeling
Group Test t-Iean Score Mean Score t equals Inter. Post 2.1 Controls without 1.22
Inter. Post 4.0 Inter. Pre 2.8 .7483 Inter. Post 3 .. 4 I It .. Pre 2.3 1.76 Inter .. Post 2.1 Con'trol Pre 3 .. 2 0 .c.Qntr.oLP~d_~ 3....5... ___ Control Pre 3.6 1.05 Control Post 2.6
TABlE 7 (Cont.)
Va.lues of t beyond .05 Significant F equals
2031 NS 1.49
2.16 NS .56
2.31 NS -3.1
2.07 NS 0
2.11 NS 1.11
Values of F beyond .05
5.59
4.67
5.32
4.30
4045
,-
Signif-icant
--
NS
NS
NS
NS
NS
'-'" ("
t7
same was accepted in those comparisons. The research hypothesis
was not aC06Dted.
A final objective of the data analysis of the information ob
tained from the Job Satisfaction Audit Tool ~as to determine if the
3C nursing staff had recognized the planned changes that had
occurred during the experimental period and if they saw those
changes as motivators. To identify this their individual replies
to the question asking 1mat changes had taken place a.nd if there
had been an increase or decrease in recognition, aChievement, work
itself, responsibility, advancement, and growth was noted from the
posttest questior~aires.
From the question that asked for a. description of chan~e5 that
had taken place the following changes were noted: three people saw
improved staffing. four people felt an increase in responsibility
or an increase in what was expected of them, two Aides noted a
change intNdr position to that of Unit Clerk, one person recog
nized a change in the manner in which report was taken and assign
ments made, one person experienced a leadership opportunity, and
one person felt an increase in paper 'T.rork. ~"Inen asked about re
cognition for achievement only three people identified a specific
example. They cited the three month post-hire evaluation as a
source of recognition for achievement. Teaching inservices to the
3C staff was recognized as an opportunity to achieve by one person.
Another individual stated that knowledge of nursing increases your
opportunity to achieve. In response to the question regardin~ a
change in ·...Tork itself or job assigments, two peo~le identified an
increase in responsibility, one saw heavier Fatient assigr~entst
another recognized additional duties for staff nurses. An Aide
saw promotion to the Unit Clerk Fosition as a chan~e in work itself.
A change in amount of responsibility for work was seen by one per-
son as more paper work and an LPN felt that the team leaders relied
on her more to make accurate observations. The only advancement
noted was by an Aide promoted to the Unit Clerk position. The
final motivator question asked if a change in opportunity to learn
or advance in skills was noted. One person felt she achieved this
from inservices and two Aides felt the RNs aided their learning.
~ ~ ~ ~ ~ Questionnaire
In this questionnaire the staff was asked to rank 12 factors,
in order of priority, as they considered an ideal job. Number one
was the factor most preferred in an ideal job and number twelve was
the factor least preferred. Then after ranking the factors the
staff was asked to distribute 100 points among the factors giving
the highest number of points to the factor most preferred and the
lowest number of points to the factor least preferr9d. The 12
factors ~oTere:
High (salary) A chance to make full use of your (abilities) Helpful and cooperative (associates) Comprehensive fringe (benefits) A boss who provides autonomy, help when needed, and
recognition Y..lhen deserved (supervision) Friendly, cordial relations with patients and thei~
families (relationshios) Relati'Te freedom from (tension) and pressure (Cnportuni~ies to learn) new things (J~b security) -A chance to make (indeFendent decisions)
A sense of really (helping others) A stable ~Norking (schedule)
Reference to these factors throughout the rest of the text
69
will be through use of the words in parenthesis. In the posttest
the experimental and the control units combined ranked the 12
factors in the following order (see Appendix G for complete
derivation) :
RNs, LPNs, and Aides (N-34 l 1- Abilities 2- Opportunity to Learn J- Helping Others 4- Supervision 5- Salary 5- AssOCiates 6- Independent Decisions 7- Relationships 7- Tension 8- Job Security 9- Schedule
10- Benefits
There was a difference in how the RNs, LPNs, and the Aides
ranked the 12 factors:
RNs (N-I?) 1- Abilities 2- Opportunity to
Learn J- Su"Oer"l'ision 4- Helping Others 5- Independent
Decisions 6- Associates 7- Salary 8- Job Security 9- Relationships
10- Tension 11- Schedule 12- Benefits
LPNs (N=R) 1- Abilities 2- Cpportunity to
Learn J- Helping Others 4- Tension 5- Salary 6- Schedule 7- Associates 8- Supervision 9- Job Security 9- Indenendent
Decisions 10- Relationships 11- Benefits
Aides (N=9) 1- Abilities 2- Supervision 2- Opportunity to
Lea.rn 3- Helping Others 4- Sa.lary 5- Associates 6- Schedule 7- Benefits 8- Relationships 9- Tension
10- Independent ~cisions
11- Job Security
The experimental unit rated the 12 factors differently in
the pretest than in the posttest.
Pretest (N=16) 1- Associates 2- Cpportunitv to Learn 3- Abilities 4- Supervision 5- Helping Others 6- Relationships 6- Tension 7- Independent Decisions 8- Salary 9- Job Security
10- Benefits 11- Schedule
Posttest (N=20) 1- Abilities 2- Opportunity to Learn 3- Helping Others 4- Salary 5- Associates 6- Supervis!on 6- Relationships 7- Independent Decisions 7- Schedule 8- Tension 9- Job -Security
10- Benefits
70
The control units also rated the 12 factors differently in
the pretest than in the posttest.
Pretest (N=l?) 1- Abilities 2- Opportunity to Learn 3- Supervision 4- Associates 5- Helping Others 6- Schedule 7- Relationships 8- Salary 9- Independent Decisions
10- Job Security 11- B"enefits 12- Tension
Posttest (N=14) 1- Supervision 2- Abilities 3- Helping Others 4- Opportunity to Learn 5- Independent Decisions 6- Associates 7- Tension 8- Salary 9- Job. Security
10- Relationships 11- Schedule 12- Benefits
Because of the large number of those completing the question-
naire did not properly complete the point distribution it was not
possible to consider this data.
CHAPTER 5
DISCUSSION AND RECOMMENDATICNS
Discussion
One research hypothesis tested by this study was that the
measured level of job satisfaction in a group of nurses would in
crease if motivators were provided. The Job Satisfaction Audit
Tool asked if, because of ~~e changes, there had been an increase
or a decrease in the amount of satisfaction obtaL~ed from work.
The 3C nursing staff responded that their amount of satisfaction
had increased. They identified changes and responded positively
about them. However, ~~ey responded the same ~ay in the pretest.
The control units also identified that their amount of job satis
faction had increased and they felt positive acout changes made in
the last nine months. Therefore, the effect of the motivators
introduced on 3C must be questioned.
Looked at individually, it was noted that JC did not see an in
crease in recognition, achievement, work itself, or advancement.
The staff did see an increase in responsibility and growth. Since
the control ~~its saw an increase in recognition, achievement, and
work itself, it 1s questionable whether the ac~ivities planned for
JC acted as motivator factors.
A..."l evaluation of the planned 'notivator aetivi ties for :;C indi
cates that not all of the activities were successfully completed.
72
The co~~ittees formed to improve between shift report and to de
velop an improved method of assigning patients successfully com
pleted their tasks and implemented ~~e changes. The aide skill
classes were held monthly and a good level of attendance and in
terest from the aides was noted. Monthly insarvices for the entire
staff on a topic of common interest and to refresh their skill
levels were provided.
The plan for every RN on the unit to hold at least one con
ference per week with their team members was not successful for
many reasons. The staff frequently said that they were too busy
to hold them. Due to the lack of structure for the conferences
many of the RNs found it difficult to know ~14'hat to do during the
conferences. Time restrictions prevented the supervisor from ccn
ductin;; the conferences which could hav·3 demonstra.ted to the staff
the value of the conferences and specific ways to conduct them.
The plan for the pre-operative patient teaching program was com
pleted and the program approved by the hospital administration and
by the physicians involved. However, initiating the program had to
be delayed because of the resignation of some of the key nursL~g
personnel on the unit.
The team rounds plan was also not successful. The staff did
not accept the idea and frequently resisted attending them by
saying they ~ere too busy. Due to the resignation of ~e u~it
cltnicia.-., and aga.in due :'0 time restric tions on t..':.e suoervisor not
enou~h rounds were hel~ to demonstrate their worth. A third staff
com~ttee did work on a unit orientation program for new employees.
73
The work, however, was not completed before the end of the experi
m~ntal period. The new apuroach of direct person-to-person dis
cussions to solve staff interpersonal problems was initiated ~Nith
varying degrees of =UCC6SS. In retrospect it is felt that it might
have been more successful had inservices on confronting and COID.."111.U'l
ications skills been provided. General unit problems were taken
into staff meetings to be solved and proved to be a successful way
of handling unit problems. Finally, ene of the most successful
acti~rities proved to be the individual projects. Many unit problems
were solved and unit operations improved by the projects.
Because of the lack of completion of some of the motivator
activities, it is understandable that the JC staff did not see an
increase in recognition, achievement, work itself, and advancement.
Referring to Appendix A it can be noted which activities provided
each motivator factor. Recognition was provided by the com..~ttee
work and the individual projects but none was received by the team
conferences, team rounds, or by the pre-op teaching program.
Achievement was gained by the committees, aide skill classes, in
services, indivijual projects, and comprehensive patient care but
not throu~h te~~ conferences, team rounds, or the pre-op teaching
program. Work itself was improved by the mova towards comprehensive
patient care but this ~aght not have been a great enough change in
the nursing aoproach. Finally, only three people received an
advancement during this time.
The sta.:"f iid see a.'"1 increaEe in responsibility which could
have come from committee wor~unit problem solvin~, interpersonal
74
orcblem solvinz, in"ividual p!"'ojects, and comprehensive patient
care although not from te~~ ~onferenceS, team rounds, and the pre
op teaching program. The other increase was seen in growth which
was possible through committee work, aide skill classes, inservices,
unit problem solving, interpersonal problem solving, individual
projects and comprehensive patient care but not from team confer
ences and the pre-op teaching progrrum.
In looking again at Table 5 it can be determined that there
was a difference in the recognition of motivator activities accord
ing to the level of the staff. LPNs saw an increase i~ recognition
and achievement, but RNs and Aides did not. RNs and LPNs saw an
increase in responsibility; whereas, Aides did not.
A further indication of a change in the level of job satis
faction can be obtained by the question in the Job Satisfaction
Audit Tool which asked for a rating from one to seven of how
strongly ?Ositive and negative job feelings were affected by the
changes. The 3C positive feeling mean score increased from 2.9 to
4.8 which was a statistically significant increase. The negative
feeling mean score also increased from 2 .. 9 to J.6 but ',.J!lS ~10t a
significant increase. The control units' positive feeling mean
score increased from 3.2 to 3.5 and ~he negative feeling mean score
decreased from 3.6 to 2.6; however, !1ei ther change 't .... as statistical],:!
siznificant. These scores demonstrate that positive feelings were
significantly incre~sed on JC; whereas, they ~ere not en the central
units. It is ~lso notable :~at 3C's ne~ative l~elin~s inc!'eased
while the control units' negative feelings decreased. Since the
75
hygiene factors were not maninulatec on any of the units, variables
that could have affected the chan~es on )C were the ~otivator
factors.
Of interest was the fact that the majority of the staff iden
tified both a change in their positive and negative feelings. This
is further confirmation of Herzberg's theory of job satisfaction
and job dissatisfaction being comprised of factors separate and
cistinct from each other.
Based upon ~~e findings it is concluded that the first re
search hypothesis that the measured level of job satisfaction in a
grou9 of nurses would increase if motivators were provided was only
weakly sup~rted. Supporting the hypothesis was the fact that the
3C staff reported their amount of satisfaction had increased and
their positive feelings also increased to a si~ificant level.
However, because the control units, who did not receive motivator
factors, also reported an increase in their ~~ount of satisfaction
and because )C saw an increase in only two of the six motivator
factors, the hypothesis car.not be strongly accepted.
It is DOssible that the tool did not accurately measure job
satisfaction and dissatisfaction. ~~re accurate or complete infor
mation mi~ht have been obtained had the tool been used in ~~e oral
interview situation for whi~h it was designed. The length of time
between tests might also have affected the results. It is not
kno~~ how long ~ctivator fa.ctors af:ect the level of job satisfac
tion or even hew long it takes to effect a ccange i~ attit~~es.
Studies of orthodox job enrichment show that the largest gai~s
76
in job satisfaction came after the longest ~ob enrichment trial
oeriods (Paul, aobertscn, & Herzberg, 1969). In this study, the
experimental period lasted nine months. The nine month duration
was selected at the beginning of the study based U90n the estima
tion that it would take no longer than nine months to complete the
motivator activities. As can be seen by the number of activities
that were not totally affected, this estimation proved to be inac
curate. Premature testing would obtain an inaccurate representa
tion of L~e staff's attitude.
It is also possible that the r9sults obtained were not repre
sentative of the entire staff. lNhile the percent of the question
naires returned was relatively good, 50% in Je's posttest, it is
possible that the attitude expressed by those who returned the
questionnaire was not representative of the entire staff. It is
difficult to obtain a lOO~ participation of a group being tested
when the completion and return of questionnaires is left voluntary.
It should De noted that a higher return was obtained in the postte~
when ~~e staff was given time to complete the questionnaire while
at work.
The second hypothesis tested by this study was that the turn
over rate in a group of nurses would decrease if motivators were
provided. The turnover rate was lower during the nine month exper
imental period ttan i t ~tif, S d'.lring the same nine month periocs of the
preceding years. ~hile this decrease appeared lar~e, from cl~ in
1975 and 56~ in 1976 to 43~ during the study, the decrease was not
statistically si:znificant. Therefore, the research h:ypothesis tha.t
77 the turnover rate would decrease if motivators ·..;ere provided was
not statistically supror:ed.
This failure to support the hypothesis cOUld have been due to
the fact that all of the planned motivator activities were not
successfully completed as discussed earlier. Also since it is not
known how long it takes to change attitudes by providing motivator
factors it ~ay take a long~r period of time to demonstrate a signi-
ficant decrease in the turnover rate.
Finally, ~~e secondary purpose of this study was to determine
if the nurse's work environment was actually chan~ed so ~~at it was
meeting their needs. To determine what nurses value in a job Your
Ideal Job questionnaire asked the staff to rank twelve factors in
order of priority as they considered an ideal job. The experimental
~~d control units in the posttest ranked the twelve factors in the
fo1~owing order:
1- Abili ti es 2 - Oppo rtuni t y to Learn J- Helping Others 4- Supel""'rision 5- Salary 5- Associa. tes 6. Independent Decisi~'ns 7- ~elationships
7- Tension 8- Job Security 9- Schedule
10- Benefits
:,mat is si~nificant in this ranking is that it suoports the
fincin?s discussed in the review of ~he literature, that wages and
the ~ours ~Torked are not the :najor r-easons for a hi gh turnover r8te
as has been ass~~ed in ~~e oast. L~ ~his study salary ranked fifth
78
and schedule and benefits ranked last. The review of the literature
revealed that ~ .. ;hat nurses want the most from Hork are social and
psychological rewards. Specifically, what is of importance to them
are co~~unications, role definitions, supervision, relationships
with co-workers, onoortun1ty to use experience and ability, lea~ing
opportunities, clinical advancement, and recognition. Again the
ranking in this study supports this.
The experi~ental unit ranked the twelve factors in a slightly
different order. Their ranking in the pretest was:
1- Associa.tes 2- Opportunity to Learn 3- !bili ties 4- Supervision 5- Helping Others 6- Relationships 6- Tension 7- Independent Decisions 8~ Salary 9- Job Security
10- Benefits 11- Schedule
This rankin~ is a.n indication of how the JC staff viewed their work
needs at that tima. To determine if the environment was ch~ged to
~eet their needs, it was noted wtat activities the staff identified
with the motivator factors.
The three month probationary evaluations were thought to have
provided recogni ti'~n for achievement. Teaching inservices a.nd
increasing nursing knowled~e were noted as opport~~ities to achieve.
Increased responsibility, heavier patient assignments, added duties
for staff nurses, and the promotion of Aides to the Unit Clerk
position were lis~ed as c~anges in work itself or job assigr~~ents.
79
!-1ore paper 11\j·ork and R...':s relying u~on observations made by LPNs 'J'iere
activities the staff noted as chan~es in the ~~ount of responsibil
ity for work. The promotion of Aides to the Unit Clerk position
was the only adv~~cement noted. Inservices and on ~~e spot teach
ing were identified as changes in opportunity to learn or advance
in skills.
Comparin~ ~~e changes the staff identified to the activities
planned as motivator factors shows that in general the staff did
not recognize the planned activities as motivators. The only acti~
ities they recognized were inservices, the promotion of Aides to
the Unit Clerk position, and RNs relying upon the observations
made by LPNs which was a result of t..l-te comprehensive patient care
method of assi~ent.
The posttest answers to the question in the Job Satisfaction
Audit which asked if the staff had noticed any changes in their
work also indicated whether they had recognized the planned moti
vator activities. Tne following chan~es were noted: improved
staffing, an increa~in responsibility and what was expected of
them, change in report and assignment method, a leadership oppor
tunity, and an increase in paper work. The only planned activities
that the staff recognized in this question were the promotion of
Aides and the change in report and assignment method. Again it was
demcnstra. ted that the staff did !'lot recogni zs tr:e planned activities
as motivators. However, since the length of effect that motivator
activities have is not ~nown, i~ is possible ttat a r.otivating
effect ~ight have diminished before the posttesting was done.
80
in general it is most likely that the motivator activities
planned did not change the work environment so that it i..ras COlT!-
pletely meeting the staff's needs. However, an effect was noted.
In the posttest the staff ranked the twelve fa.ctors differently
than they did in the pretest.
Pretest Posttest 1- Associates 1- Abilities 2- Opt:·ortunity to Learn 2- ~portunity to Learn J- Abilities 3- Helping others 4- Supervision 4- Salary 5- Helpin~ others 5- Associa.tes 6- Relationships 6- Supervision 6- Tension 6- Relationships 7- Independent Decisions 7- Independent Decisions 8- Salary 7- Schedule 9- Job Security 8- Tension
10- Benefits 9- Job Security 11- Schedule 10- Benefits
Thus at the end of the study period some factors had increased in
importance while others had decreased o
Recommendations for Further Studv ~~~~~~~~ --- -----
Based upon the urgent need for an improved level of motivation
in nursing it is imperative that studies attempting to increase the
level of job satisfaction in nursing be continued. wbile the re-
suIts obtained in this study did support Herzberg's Theory of
Motivation; a dramatic increase in job satisfaction was not ob-
tainedo Different motivator activities need to be tried.
The motivator activities in this study only affected isolated
portions of each nurse's job. Those changes were attempted in the
existing structure and system of the hospital and the nursing
department. The basic method of deliverin~ nursing care was not
81
chan~ed. Each nurse's job remained essentially the same. There
fore, it is Leco~~ended that a study of motivaticn ~~d job satis
faction be repeated after the method of delivering patient care is
chan~ed to a nursing approach that is consistent with Herzberg's
Theory of Motivation and Orthodox Job Enrichment. A nursing
approach that appears to be consistent with Herzberg's Theory and
Orthodox Job Enric~~ent is Pri~ary Nursing.
Primary nursing is a concept that has been gaining in popular
i ty in recent years. One defiri tion of pri~ary nursing is Itthe
distribution of nursing so that the total care of an individual
patient is the responsibility of one nurse, not many nurses"
(Marram, Schlegel, & Bevis, 1974).
Primary nursing does provide Herzberg's motivator factors of
recognition, achievement, work itself, responsibility, growth,
and advancement. It also provides all of the ingredients necessary
for Orthodox Job Enric~m9nt. Those ingredients are direct feed
back, a client to employee relationship, a learning function, ~~e
opportunity for each person to schedule his own work, unique exper
tise, control over resou~ces, direct communicaticn, and personal
accountability. Studies have demonstrated primary nursing does
increase job satisfaction ~nd facilitates improved patient care
(Brown, 1977; Marram, Schlegel, & Bevis, 1974).
Wbile the testing in th~5 study of ~he intermediate care unit
did not produce d~a:natic !'esults in favor of primary nursin~, those
results :-nus t be vi ewed in pers pee ti ve • Tn e U!li t ~:, d j'.l:~ t ~o'1e:i
to~ards initiatin~ a tJ~e of primary ~ursing three months ?rior to
82
the posttesting. The type of nursi~g actua~ly beir.g practiced at
that tiT.e w:S.s not primary. It cC'.lld h!7 m=re a.ccura~ely classified
as modular nursing. It ';-1305 prac ticed only on the day shift and 'the
evening and night shifts practiced te~~ nursing.
A second recommendation for further testing would be to con
tinue using the ~..rri tten questionnaires that ',yare 6i ven 1n this
study, but a. higher return must. be obtained. To obtain a hi.;sher
return rate it is reco~ended that the importance of the informa
tion be highly stressed to the staff. Also time must be provided
when the questionnaires are handed out to allow the staff to com
plete them and return them immediately. A low return rate results
when staff members are told to take the questionnaires home, fill
them out, and return them at a later date.
A final recommendation would be to include cost effectiveness
measurements to help evaluate any change designed to increase job
satisfacticn in the nursin~ profession. In light of the spiraling
heal~~ care costs and the increasing consumer demand for health care
that is of high quality but also economical, the cost effectiveness
of various a09roaches is going to be a serious consideration in the
future.
In conclusion, it is essential that methods of increasing job
satisfaction in nursing be discovered. Nurses are beginning to
demand that work satisfy more o~ their needs. 2ecausa of rising
heal t~ cgre costs, COnSl.L.11erS are beginning to d.e01.a~d economical,
hi~h quality health care and hospital administra.tors are lcoKin~
for ways to increase t.he efficiency of its health care croviders.
83
The '~uali ty of patient care that nurses can provide is adversely
affected 'cy a high turnover ra:e and a low level of job satisfac
tion. All of these pressures make it imperative that studies
researching possible ways to increase job satisfaction and motiva
tion in the nursing profession be continued. Enough time and effo~
has been spent studying why nurses are unhappy and why ~~ey quit
their jobs and professicn, it is now time to sta.rt. evaluating
practical applications of methods designed to improve the nursing
approach. It is only through such research that ~ays to increase
job satisfaction in the nursing profession will be discovered.
While this study did not produce a dramatic increase in ~~e
measured level of job satisfaction or a dramatic decrease in the
turnover rate, it did have a positive effect on the nursing staff.
It demenstrated that it is possible to increase job satisfaction
and decrease the turnover rate. It demonstrated that even if a
major change cannot be effected in a nursin~ approach being prac
ticed, it is possitle ~o design sc~e changes in the existing
system that will have a positive effect. Finally, this study
disproved the common fallacies w~at nothing can be done to increase
job satisfaction in the n~rsing profession because i~ is a wo~~'s
profession and because the wages and the hours worked cannot be
chan~ed. Job satisfactiC'n ,3....'"1d !1'1otivation in the nursing profession
can ~nd ~ust be increased.
APPENDIX A
MOTIVATOR ACTIVITIES AND CORRESPONDING
MOTIVATOR FACTORS AND
ORTHODOX. JOB ENRICHMENT INGREDIENTS
85
Orthodox Motivators Activities !l.2E Enrichment
achievement growth committees personal recognition accountability responsibility
achievement growth aide skill classes learning
achievement growth inservices learning
achievement direct !eed.bac k growth team conferences learning recognition personal responsibility accountability
achievement growth pre-op teaching personal recognition accountability responsibility
achievement direct feedback recognition team rounds learning responsibility communications
personal accountability
growth unit problem personal responsibility solvin~ accountability
growth interpersonal personal responsibility problem solving accountability
achievement learning growth individual C ommunica ti ons recognition projects personal responsibility accountability
achievement direct feedback growth comprehensive client to employee responsibility patient care relationship work itself opportunity to
schedule own work
unique expertise c ontr 01 over
resources c orn..m.unic a. ti ons
APPENDIX B
JOB SATISFACTION AUDIT
JOB SATISFACTION AUDIT
1. Have you noticed any chan~es in your work. that you have been asked to do in your job over the last 9 months?
Describe the changes that have taken place.
a. \'Jhat were your job assignments before the change(s)1
b. What are your job assignments now?
2. Specifically. has there been an increase or decrease in the following: 1. Recognition For Achievements--how much recognition you have
received for the work you do?
20 Achievement--a change in your opportunities to achieve on the job?
3. Work itself--a change in the ~e of work you do? Your job as sig!'l.ments 7
4. Responsibility--a change in the amount of responsibility you have for your work?
COPYRIGHT © 1975 FREDERICK HERZBERG ALL RIGHTS RESERVED
88
5. Advancement--a chan~e in the complexity of the task? An advancement to a higher skilled job?
6. Growth--a change in your opportunity to learn more on the job, an advancement in your skills?
3. How did you feel about the changes?
a. wby did you feel the way you did?
4. Because of the chan~e(s) has there been an increase or a decrease in the amount of satisfaction you are getting from your work?
5. Did the changes affect you personally in any way?
a. Did it change the way you get along with people in general or with your family?
COPYRIGHT © 197.5 FP-EDERICK HERL3E.RG ALL RIGHTS RJ::.SERv.c£D
b. Did it affect your sleep, appetite, digestion, general health?
6. I would like you to rate on a scale from one to seven how strongly your feelings about your job were affected by the changes.
Changed a No Change Great Deal
a. 1 2 ~ 4 5 6 7 Positive .,t
Changed a !fo Change Great Deal
b. 1 2 3 4 5 6 7 Negative
COPYRIGHT © 1975 FREDERICK HhRZEERG ~..LL RIGHTS RESERV~D
feelings
feelings
89
APPENDn c
YOUR IDEAL JOB
91
YOUR IDEAL ,]C3
1. Rank each of t~e follm~ng factors in the order of priority to you as you consider an ideal iob. Give a rank of "III to the item that you !!!,2ll prefer in an ideal ,job and. a rank of "1211 to the item you ~ prefer, and so on for the !actors in between.
2. After completing the ranking, then distribute 100 points among the eight factors. Give the highest n~~ber of points to the item you prefer !!!,2ll, the lowest number of points to the factor you prefer 1!!!1 and so on for the items in between. Ple&se check to be sure that the numbers add to 100.
RANKING POINTS FACTCiiS
High salary
A chance to make full use of your abilities
Helpful and cooperative associates
Comprehensive fringe benefits
A boss who provides autonomy, help when needed, and recognition when deserved
Friendly, cordial relations with patients and their families
Relative freedom from tension ~nd pressure
Opportunities to learn new things
Job security
A chance to make independent decisions
A sense of really helping others
A stable working schedule
___ Total= 100
APPENDn D
BIOGRAPHICAL DATA
93
INSTRUCTIONS
This questionnaire is ccncerned with job attitudes in nursing. Please ans~~r each question carefully and honestly. All information given will be kept in strict confidence. Your assistance will be greatly appreciated.
BIOGRAPHICAL DATA
Hospital
Social Security Number - ----Age_
Present Position ______ Nursing Administration ___ Clinical Specialist ___ Supervisor ______ Charge Nurse
Staff Nurse ---___ LPN ___ NA
'ward Clerk ---other: (Please Specify) ---How Long at Present Position __________________ __
Number of Years of Experience in Nursing -----------------If RN the type of school in which you received your (basic) nursing education:
Junior College, or Associate Degree -nospita1
University or Bachelors Degree
List all further degrees you have obtained ______________________ _
List how many college credits you have earned since graduation from your basic program ________________________________ _
If LPN, NAt or Clerk please list highest level of educational achievement including number of college credits earned
APPENDIX E
DATA FROM JOE SATISFACTION AUDIT
EXPERIMENTAL PRETEST KEY: RNs, LPNs, & Aides N=16
MODE
Changes in Job 1 Recognition 2 Achievement 1 Work Itself/Assignments 2 Responsibility 2 Advancement 2 Growth 1 Feelings About Chang~s 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 2 Affect on Health 2
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY P~RCENTAGE OF GROUP 1 2 4 2 COMPLETING QUESTION 5 3 50.~ 5 9 87.5% 9 4 81.3% 3 7 4 87.5% 5 6 2 81.3% 3 10 81.3~
12 2 87.5~ 7 2 1 2 75.a% 8 6 87.5% 6 5 68.~ 6 7 81.'3~ 5 8 81.3~
'-D \Jl
BXPffiIMENTAL PooTTEST KEY: RNs, LPNs, & Aides N=20
MODE
Changes in Job 1 Recognition 2 Ac hi eveme nt 2 Work Itself/Assignments 2 Responsibility 1 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 1 Affect on Health 2
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUEl£Y PERCENTAGE OF GROUP 1 2 4 2 COMPLETING QUESTION 5 J 40.0 7 10 85.0 6 8 75.0 3 11 3 85.0 8 7 2 85.0 4 9 75.0 9 7 80 0 0
10 2 6000 10 2 2 70.0
9 4 70.0 8 6 75 .. 0 5 9 75.0
'-0 a..
EXPERIMENTAL UNIT KEY: POSTTEST RNs N=9
MODE
Changes in Job 1 Recognition 2 Achievement 2 Work Itself/Assignments 2 Responsibility 1 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 1 Affect on Health 2
1- Yes an increase 2- No a decrease 4- Y~s an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY P~CENTAGE OF GROUP 1 2 l~ ~ COl~PlETING ~UJ£STION 2 0 22.2 2 5 77.8 2 5 77.8 1 5 1 77.8 4 :3 . 77.8 2 5 77.8 4 :3 77.8 4 2 66.7 4 1 1 66.7 4 0 55.6 :3 :3 66.7 2 4 66.7
'-'l ~
bXP~IMENTAL UNIT KEY: FOSTTbST LPNs N=6
MODE
Changes in Job 1 Recognition 1 Achievement 1 'dork Itself/Assignment 2 Responsibility 1 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfactlon 1 Personal Affects 1 Relations to People/Family 1 Affect on Health 2
1- Yes an increase 2- No a decrease 4- YbS an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY PERCENTAGE OF GROUP 1 2 4 ~ COMP~TING WU~STION 2 2 66.7 3 2 8303 3 1 66.7 1 J 1 83.3 3 1 1 83.3 1 J 66.7 2 2 66.7 2 0 33.3 3 0 50.0 2 2 66.7 3 1 66.7 1 J 66.7
'\,() (X)
EXPeRIMENTAL UNIT Key: FOSTTEST AIDES N=5
MODE
Changes in Job 1 Recognition 2 Achievement 2 w:ork Itself/Assignments 2 Responsibility 2 Advancement Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 1 Affect on Health 1
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY PERCENTAGE OF GROUP 1 2 4 :i COMPLETING QU~STION 1 1 40.0 2 3 100 0 0 1 2 80 0 0 1 3 1 1000 0 1 3 1 1000 0 1 1 80,,0 3 2 1000 0 4 0 80,,0 3 1 1 100 0 0 3 2 100.0 2 2 100 .. 0 2 2 100.0
'-0 '.()
INTERMEDIATE CARE UNIT KEY: PRETEST RNs, LPNs. & Aides N=5
MODE
Changes in Job 2 Reco?:nition 1 Achievement 1 Hark Itself/Assignments 2 Responsibility 2 Advancement 2 GrOl.Jth 1 Feelin~s About Changes 1 Amount of Satisfaction 1 Personal Affects 2 Relations to People/Family 2 Affect on Health 2
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUE.OCY PERCENTAGE OF GROUP 1 2 4 .2 COMPLETING ~UESTION 0 1 20.0 4 1 100.0 2 2 80.0 0 4 80.0 2 3 100.0 1 4 100.0 4 1 100.0 4 0 80.0 2 0 2 80.0 1 3 80.0 1 2 60.0 0 3 60 0 0
....... o o
INTERMEDIATE CARE UNIT KI!:Y: POSTTEST RNs. LPNs, & Aides N=-9
MODE
Changes in Job 1 Recognition 1 Achievement 1 \-/ork Itself/Assignments 1 Responsibility 2 GrOtrth 1 }i'eelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 2 Affect on Health 2 Acivanceroent 2
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY P~CENTAGE OF GROUP 1 2 4 2 COMPLETING QUESTION 3 0 33.3 6 3 100 0 0 6 2 88.9 4 3 1 88.9 2 6 88.9 8 1 1000 0 6 0 1 1 88.9 4 2 0 1 77.8 4 J 77.8 2 6 88.9 J 5 88.9 2 5 77.8
~ o ~
CONTROL UNITS KEY: PHETEST RNs, LPNs, & Aioes N=17
MODE
Changes in Job 2 Recognition 1 Achievement 2 lv/ork Itself / Assignments 2 Responsibility 2 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects ]
Relations to People/Family 1 Affect on Health 1
1- Yes an increase 2- No a decrdase 4. Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY PERCENTAGE OF GROUP 1 2 4 2 COMPLETING ~UESTION 2 5 41 .. 2 9 6 88.2 5 8 76 .. 5 J 9 1 76 .. 5 5 9 82.4 1 13 82 .. 4
12 2 82.4 9 2 64 .. 7 6 1 4 2 76.5 9 3 70.6 1 4 64.1 6 6 70.6
I-' o f\)
CONTROL UNITS KEY: POSTTb.ST RNs, LPNs, & Aides N=]4
MODE
Chan~s in Job Recognition 1 Achievement 1 Work Itself/Assignments 1 Responsibility 2 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 2 Affect on Health 2
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY PERCENTAGE OF GROUP 1 2 4 2 COMPLETING QrriSTION 3 0 21.1~ 8 4 85.7 8 3 78.6 6 4 1 78.6 J 8 78.6 3 8 78.6
11 2 92.9 8 0 1 1 71.4 5 3 0 1 64.3 7 3 71.4 J 8 78.6 5 7 85.7
~ o \,J
CONTROL UNITS ~~ITHOUT KEY: INTERMEDIATE UNIT P~TEST RNs, LPNs, & Aides N:=12
MODE
Changes in Job -2-
Recognition 1 Achievement 2 Hark Itself/Assignments 2 Responsibility 2 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 1 Affect on Health 1
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increase and a decrease
FREQUENCY PERCENTAGE OF GROUP 1 2 4 2 COMPI .. ETING QUESTION
'2 4 50.0 5 5 8303 3 6 75 0 0 3 5 1 75.0 3 6 75 0 0 0 9 75 0 0 8 1 75.0 5 2 58 .. 3 4 1 2 2 75.0 8 0 66.7 6 2 66.7 6 3 75.0
I--' o .(:'-
CONTROL UNITS WITHOUT KEY: INTERMEDIAT~ UNIT POSTT~ST RNs. LPNs, & Aides N::5
MODE
Changes in Job 0 Recognition 1 Achievement 1 \-lork Itself/Assignments 1 Responsibility 2 Advancement 2 Growth 1 Feelings About Changes 1 Amount of Satisfaction 1 Personal Affects 1 Relations to People/Family 2 Affect on Health 1
1- Yes an increase 2- No a decrease 4- Yes an increase but feel negative about it 5- Both an increa.se and a decrease
FREQUEl'CY PERCENTAGE OF GROUP 1 2 4 ~ COMPLETING QUESTION 0 0 0 2 1 60.0 2 1 60.0 2 1 60.0 1 2 60.0 1 3 80.0 3 1 80 0 0 2 0 40.0 1 1 40~0
3 0 60.0 1 2 60 0 0 2 2 AOoO
I-' o \...n
APPENDIX F
DATA FRCM
CHANGES IN POSITIVE FEELINGS
CHANGES IN NEGATIVE FEEUNGS
EXPhRlMENTAL UNIT PRETEST RNs. LPNs, & Aides N=16
Changes in Positive Feelings Changes in Negative Feelings
EXPiRIMENTAL UNIT FOSTTEST RNs. LPNs, & Aides N=20
Changes in Positive Feelings Changes in Negative Feelings
MEAN
2.9 2.9
MEAN
4.8 3.6
STANDARD DEVIATION
le64 1.96
STANDARD DEVIATION
2.29 1.78
PERCENTAGE OF GROUP COMPLETING QUESTION
68.8 56.3
PERCBNTAGE OF GRCUP COMPLETING QUESTION
6000 50 0 0
........ o ,1
INTERMEDIAT~ CARE UNIT PH.ETEST RNs. LPNs. & Aides N=5
Changes in Positive Feelings Chan~es in Negative Feelings
INTERMEDIATE CARE UNIT F0STTEST RNs, LPNs, & Aides N=9
Changes in Positive Feelings Changes in Negative Feelings
MEAN
2.8 2.3
STANDARD DEVIATION
1.64 1.53
MEAN STANDARD ~VI.ATION
3.4 1.67 201 1.07
PERCENTAGE OF GROUP COMPLETING QUESTION
100.0 60.0
PERCENTAGE OF GROUP COMPLETING QUESTION
1000 0 77.8
I-' o 0>
CONTROL UNITS PRETEST RNs, LPNs, & Aides N=17
Changes in Positive Feelings Changes in Negative Feelings
CONTROL UNITS POSTT1!;ST RN~. LPNs, & Aides N;:lJ~
Chan~es in Positive Feelings Chan~es in Negative Feelings
MEAN
3.2 3.6
MEAN
3.5 2.6
STANDARD lEVIATION
2.01 2.37
STANDARD reVIATION
1.57 1.94
PERCENTAG~ OF GROUP COMPLETING QUtSTION
76.5 58.8
P~CENTAGE OF GROUP COMPLETING QUESTION
78.6 64.3
....... o '-0
CONTROL UNI'fS \JITHOUT INTERMEDIATE CARE UNIT POSTTl£ST RNs j LPNs, & Aides N=5
Changes in Positive Feelings Changes in Negative Feelings
MEAN
4.0 4.0
STANDARD IEVIATION
1.41 4.24
PERCENTAGE OF GROUP COMPLETING QUESTION
40.0 40.0
........
........ o
APPENDIX G
DATA FROM YOUR IDEAL JOB:
BXPERIMENTAL UNIT PRft..TEST RHs, LPNs, & Aides N=16
Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
MEAN 7.0 5.0 4.4 7.9 5.1 5.9 5.9 l~. 8 705 6.8 5.4 8.4
RANK -8
3 1
10 4 6 6 2 9 7 5
11
STANDARD DEVIATION
3.64 3.80 2.93 3.71 3.27 3.37 2.87 2.46 2.93 3.26 4.38 3.27
PERCENTAGE OF GR0UP COMPLETING QUeSTION
87.5 87.5 87.5 87.5 87.5 87.5 81.3 87.5 81.3 87.5 87.5 87.5
I-' ...... N
EXPERIMENTAL UNIT POSTTEST RNs. lFNs, & Aides N=20
Salary Abilities Associates Benefits Supervision Rela.tionships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
MEAN 5.9 4.1 6.1 8.9 6.9 6.9 7.5 I~. 2 7.6 7.3 5.3 7.3
RANK I;-
I 5
10 6 6 8 2 9 7 3 7
STANDARD DEVIATION
3.64 3.10 3.12 3.02 3.23 3.32 3.43 2.58 2.68 3.66 3.71 3.37
FE~CENTAGE OF GROUP COMPLETING QUESTION
90.0 90.0 900 0 90.0 90.0 90.0 90.0 90.0 90.0 90.0 90 0 0 90.0
t-' t-'
I,....)
CONmOL UNITS PRETEST RNs, LPNs, & Aides N-17
Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
MEAN 6.5 3.8 4.6 7.9 4.5 6.0 8.1 4.3 7.7 7.4 5.2 5.9
RANK a-1 4
11 3 7
12 2
10 9 5 6
STANDARD DEVIATION
4.24 3.17 3.35 3.17 30 69 3.33 3010 3.38 3.70 3.28 2 0 89 2.94
PhRCENTAGE OF GROUP COMPLETING QUESTION
94.1 94.1 94.1 94.1 94.1 94.1 94.1 94.1 94.1 9401 94.1 94.1
I-' ...... +="
CONTROL UNITS POSTTEST RNs. LPNs. & Aides N-14
Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
MEAN 7.0 5.6 6.7 8.2 3.8 7.7 6.8 6.0 7.5 6.1 5.8 8.1
RANK -8
2 6
12 1
10 7 I~
9 5 3
11
STANDARD DEVIATION
3.92 3.57 3.09 3.06 2.97 3.57 3.93 3.34 4.74 4.17 3.02 3.17
PERCENTAGE OF GROUP COMPLETING QUhSTION
92.9 92.9 92.9 92.9 92.9 92.9 92.9 92.9 92.9 92.9 92.9 92.9
I-' I--' \..It
1XPERIMENTAL AND CONTROL UNITS POSTTEST RNs. LPNs, & Aides N=.34
Salary Abilities Assooiates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping others Schedule
MEAN IT 4.7 6.4 8.6 5.6 7.2 7.2 5 .. 0 7.5 6.8 5.5 7.6
~ 5 1 5
10 4 7 7 2 8 6 3 9
STANDARD DEVIATION
3.74 3.34 3.07 3.01 3.44 3.39 3.60 3.01 3.61 3.86 3.39 3.26
PERCENTAGE OF GROUP COMPLETING QUESTION
91.2 9102 91.2 91.,2 9102 910 2 91.2 91.2 910 2 9102 9102 9102
I-' I-' a-...
EXP~IMENTAL AND CONTROL UNITS POST'I'ESfr RNs N=17
Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity tb Learn Job Security Independent Decisions Helping Others Schedule
MEAN 6.7 4.6 6.4 8.9 5.5 7.4 7.5 409 102 5.7 5.6 8.A
~ 7 1 6
12 :3 9
10 2 8 5 4
11
STANDARD DEVIATION
3.10 3.65 3.14 2.86 3.29 3.32 4.10 2.99 3.92 3 .. 80 3.54 2.86
P~CENTAGE OF GROUP COMPLETING (UESTION
94.1 94.1 94.1 9401 94.1 94.1 94.1 9401 94.1 94.1 94,,1 94.1
~ --..J
EXPER~NTAL AND CONTROL UNITS POSTTEST LPNs N=8
Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
MEAN 5.8 4.3 6.3
11.0 6.7 7.8 5.7 4.8 7.0 7.0 5.3 6.2
RANK 5 1 7
11 8
10 4 2 9 9 :3 6
STANDARD DEVIATION
3.43 3.72 3.56
.89 4.32 3.92 1097 3.60 3.29 4.00 2.80 2.79
PERCENTAGE OF GROUP COMPLETING QUESTION
75.0 75.0 75.0 75.0 75.0 75.0 75.0 75 0 0 75.0 75.0 75 0 0 75.0
I--' I--' CD
EXPERIMENTAL AND CONTROL UNITS POSTTEST Aides N=9
MEAN' Salary Abilities Associates Benefits Supervision Relationships Tension Opportunity to Learn Job Security Independent Decisions Helping Others Schedule
6.l 5.1 f;.) 6.6 5.2 6.6 1.8 5.2 8.6 8.4 5.7 6.4
RANK -;;-
1 5 7 2 8 9 2
11 10 3 6
STANDARD DEVIATION
4.34 2"Ao 3.00 2.96 ).)8 3047 3.53 2.99 3.43 3.68 3.84 3.71
PERCENTAGE OF GROUP COMPLETING QU~STION
100 0 0 100 0 0 1000 0 1()0.0 100.0 100.0 100.0 100 0 0 100.0 100 0 0 100.0 100.0
t-' t-' '-D
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Name
Birthplace
E1rthdate
High School
University 1967-1971
Degree 1971
Professional Positions
VITA
Tanna S. Ferrin
Caldwell. Idaho
August 10, 1949
Vallivue High School Caldwell. Idaho
Idaho State University Pocatello, Idaho
B.S.N., Idaho State University Pocatello, Idaho
Staff Nurse, Relief Eveni~' Supervisor 6/1971-8/1973 -Veterans Administration Hospital Boise. Idaho
Unit Supervisor 4/1974-Holy Cross Hospital Sa.1t Lake City, Utah