Motivation of personnel labor is a key direction of the personnel policy of any enterprise. However, not all tools that allow highly effective management of the behavior of employees of commercial companies are also effective in managing medical personnel.
In the health care system, nursing staff are the most significant part of the workforce. The professional activities of nurses are particularly influenced by such negative factors as insufficient prestige of the profession, relatively low wages, difficult working conditions, which complicates the management process. In this regard, it is extremely important to clearly motivate the activities of nurses in the changing management structure of medical institutions.
The concept of labor motivation in the economic sense appeared relatively recently. Previously, the concept of motivation was replaced by the concept of stimulation and was used mainly in pedagogy, sociology, psychology. This limited understanding of the motivational process led to a focus on getting immediate results. This did not cause significant interest of the nursing staff in their own development, which is the most important reserve for increasing labor efficiency. Labor has ceased to be the meaning of life for many people and has turned into a means of survival. And in such conditions, it is impossible to talk about the formation of a strong work motivation, about the efficiency of work, the improvement of the qualifications of workers and the development of initiative.
In health care, simple material rewards are considered sufficient as the main motivational factor. Sometimes this policy is successful. And since a motive is a conscious urge to achieve a certain goal, understood by a person as a personal need, a need, then the structure of the motive includes, in addition to needs, actions to achieve them, and the costs associated with these actions.
Motivation is represented by motivation and stimulation. If motivation is the process of influencing a person in order to induce him to certain actions by awakening certain motives in him, then stimulation consists in using these motives.
With the development of health care, more and more attention is paid to the motivational function of management, when preference is given to motivation over administrative and strict control. Moreover, the most common group of motivating factors is not “carrots and sticks” and not fear and disciplinary responsibility, but a group of factors including trust, authority, and reward. Employment guarantees and working conditions are of great importance.
Five levels in the system of motivation for the work of nursing personnel of medical institutions can be presented in the form of a kind of pyramid, at the base of which there is such a component of motivation as the principles of leadership, the other components of motivation can have the following arrangement according to the levels of the pyramid (see Fig. 2).
Fig. 2.
The motivation of medical personnel and their actions to achieve certain goals are guided by values that are prioritized. At the same time, research often refers to the scoring of values.
On the example of one of the medical institutions in Novosibirsk, in 2012, studies of the distribution of values by priorities of nurses were carried out (researchers A.I. Kochetov and E.I. Loginova). As a result of the survey, nurses put salaries, health care, and job satisfaction first. The second and third places are the respect of colleagues, good relations with them, as well as encouragement from the administration. Equally important for nursing staff is the possibility of self-realization, social package and recognition in the organization. The possibility of self-realization in the profession was indicated by 23% of the respondents. This figure is explained by the fact that the functions of nursing staff are more limited in comparison with doctors. The work is perceived as monotonous. The sisters often perform it mechanically, without delving into the essence of new tasks. Professionalism in narrow specialization is growing and interest in self-education is declining. It should be emphasized that when asked about further cooperation with the organization, 7% of the nursing staff of the medical institution expressed dissatisfaction with the current state of affairs, and 22% left the answer to this question. Thus, a survey of nurses showed that about 30% of staff do not agree to continue working on the same conditions. This suggests that in order to retain staff, changes are needed both in the remuneration system and in the nursing staff management structure.
In order to identify the preferred types of labor stimulation for nursing personnel, the same researchers (A.I. Kochetov and E.I. Loginova) conducted a survey of nurses at one of the clinical diagnostic centers in Novosibirsk. The research results showed that 77.5% of respondents preferred material incentives. Among non-monetary material incentives, nurses preferred the provision of preferential vouchers for rest and treatment (71.5%); improvement of working conditions, ergonomics of the workplace (66.5%); introduction of flexible working hours (62.5%); provision of benefits for payment of departmental housing and utilities (59%); voluntary medical insurance of personnel (44%); organization of reduced price meals (44%). Among the preferred forms of moral encouragement, the majority of respondents noted: attentive attitude to individual proposals aimed at improving the common cause (69%); announcement of gratitude (59%); one-time granting of powers in solving certain production issues (22%).
After analyzing the data on the preferred types of motivation, we can conclude that each specific employee has a motivational system peculiar only to him, which depends on the personal qualities of the person and the life circumstances in which he is currently. It is necessary to strive to orientate motivation to values that are of priority importance for a particular nurse.
The prestige of the profession of a nurse, as noted earlier, plays one of the essential roles in the structure of work motivation of nurses. It is not so easy to raise the prestige of the profession, and this is a common task not only of the health care system, but also of the cultural state of the whole society, the hierarchy of social values. The labor motives and values of the Western model, introduced into the mass consciousness of Russians from the outside, do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements of economic development. The decline in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere.
There is no widespread propaganda of the public importance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture.
Thus, it is possible to determine the main areas of activity of healthcare leaders at various levels of management, aimed at maintaining and increasing the work motivation of nurses (Table 2).
table 2
The main directions of increasing the work motivation of nurses
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at the level of government |
at the local government level |
at the management level of the organization |
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1. Increasing the prestige and widespread promotion of the public importance of the nursing profession. Rendering recognition to employees and veterans of the profession. |
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2. Establishing a decent level of wages for nurses. |
2. Organization of seminars, conferences, competitions at city, district, regional levels, exchange of experience between various medical institutions. |
2. Development of a system of additional material incentives for employees, creating opportunities for preferential medical care for employees and their families. |
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3. Equipping medical institutions with modern equipment and the introduction of modern technologies. |
3. Allocation of additional funds for technical and technological equipment of medical institutions. |
3. Development of organizational culture: popularization of the mission, the formation of loyalty and commitment of employees of the organization and other specific aspects. |
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4. Popularization of an increased level of secondary and higher nursing education. |
4. Organization of targeted recruits to higher educational institutions of graduates of medical schools and colleges, who have shown themselves excellently during their studies. |
4. Attention to personnel work: the creation of adaptation programs for young specialists, the study of labor motivation of personnel and the creation of motivational programs, etc. |
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5. Expansion of the hierarchical structure of health care institutions, creation of career opportunities and more differentiated pay for nurses. |
5. Attracting schoolchildren and students of medical schools and colleges to research work and popularization of medical knowledge, the establishment of personal scholarships. |
5. Prevention of professional stress and professional burnout syndrome: introduction of the position of a psychologist, training staff in anti-stress behavior skills, conducting social and psychological trainings. |
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6. Development of load standards and standards for the provision of medical care. Introduction to the staff of health care facilities of the position of HR manager and psychologist. |
6. Creating a comfortable working environment. Monitoring compliance with safety regulations. Implementation health-saving technologies. |
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7. Introduction of compulsory socio-psychological trainings (at least 24 hours) into advanced training programs for nurses. |
7. Wide involvement of highly qualified medical personnel in teaching at the departments of advanced training of nurses. |
7. Development of the nursing process as the main model for the provision of nursing care. |
Some of the measures listed in the table are being successfully implemented in the field of domestic health care at the present time, while the other part requires its detailed consideration and application.
For a long time, the characteristics of personnel motivation in the field of health care were the subject of numerous studies, in which they most often examined the issues of the importance of non-economic and economic motives. In addition, special attention was paid to the analysis of the effectiveness of changes in the organization of wages in order to increase the quality indicators of medical care provided to the population. However, it should be noted that the impact of economic and non-economic motives on the efficiency of medical personnel has been little studied.
Anything that is associated with additional benefits that can be acquired due to the fulfillment of the necessary requirements should be considered economic motives. The benefits, as a rule, can be direct, in the form of cash, or indirect, which are manifested in the opportunity to earn money elsewhere, while having more free time.
Household motives primarily include wages, all kinds of bonuses, bonuses, payments, allowances and benefits. Their tasks are to attract employees to the high-quality performance of their duties, increase staff loyalty and, most importantly, maximize work efficiency.
Non-economic motives, in turn, include socio-psychological and organizational methods of motivation.
Organizational methods are methods that contribute to the involvement of employees in solving corporate problems, as well as the manifestation of initiative. In addition, such methods are aimed at improving working conditions.
Socio-psychological methods focus on enhancing a supportive environment in the team.
Having studied the economic and non-economic methods of motivation, we should talk a little about the statistics of wages in the Irkutsk region. According to which the total number of employees is significantly reduced due to unstable and low wages. This increases the interdependence between employees, the manager, and the systems. The work of employees in a single team significantly increases the level of productivity of the organization as a whole, this happens due to the interaction of people with different views and work experience. In addition, when a company has such formal and informal groups, much less control is required. And to this day, the salary of medical personnel remains at a low level, which forces employees to take money while violating the law, but it should be said that doctors who work only for their wages and to preserve the health and lives of patients still exist.
According to reports from all districts of the Irkutsk region, the average salary of doctors is about 28 (twenty eight) thousand rubles a month, but still in some medical institutions its figure is significantly lower.
In order to increase the efficiency of labor productivity, as well as the level of qualifications of personnel, the manager should know and be able to apply not only economic and non-economic motives, but it is also necessary to use material and non-material incentives to work.
It is also necessary to familiarize yourself with the statistics of other countries, such as the United States. In the United States, according to 2014 data, the profession of a doctor is one of the highest paid, the salary of senior medical personnel is slightly more than 260 (two hundred and sixty) thousand rubles. Control over their activities is carried out mainly by the patients themselves, and in case of poor-quality service, they can sue and obtain the removal of doctors from their duties. Undoubtedly, the occurrence of such moments is another important incentive to do your job efficiently and accurately.
Therefore, we came to the conclusion that every person, to one degree or another, needs high-quality and timely medical care.
And in order for medical institutions to provide the population with the necessary assistance, staff should be motivated as effectively as possible. And one of the most important roles in the process of motivating personnel in the healthcare sector is played by additional salaries in the form of allowances, bonuses and rewards of an individual nature, as well as favorable relations between the manager and his subordinates. In addition, changes in the organization of wages are the most effective way to motivate medical personnel to improve the quality and efficiency of their work.
1, 2 Levina V.A. 12E. V. Kuznetsova 12Lunkova O.A. 121 NGOU VPO "Saratov branch of the Samara Medical Institute" REAVIZ "
2 GOU SPO "Engels Medical College", Engels
As a result of theoretical and practical research based on the analysis of various theories for the study of motivation, it can be concluded that the motivational sphere of a person is very complex and heterogeneous. With knowledge of motivational factors that are highly valued by employees, nursing team leaders can think of and build a reward and incentive system that meets the requirements of efficiency. As can be seen from the study, even if the employees are satisfied with the working conditions, it is possible to single out a number of points based on a qualitative analysis of individual questionnaires, which will allow the manager to improve the efficiency of his management. So, the scope of application of knowledge on motivation is very extensive. And the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.
nurse
motivation
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6. S.I. twins Nursing management. - Rostov n / a .: Phoenix, 2006.
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Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts. One of the simplest and most common definitions of motivation: motive is the intrinsic value of the activity being performed. In the most approximate sense, such a definition reflects the inner state of a person, however, it should be noted that the forces that induce action are outside and inside a person and make him consciously or unconsciously perform some actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react in completely different ways to the same influences from the same forces.
Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. Hence the concept of motivation stands out. Motivation is the process of influencing a person in order to induce him to certain actions by awakening certain motives in him.
Purpose of the work: to determine the practical application of psychological knowledge about motivation in the management of nursing staff in health care facilities.
In order to identify the factors of motivation of the nurses of the urological department, we conducted a survey of the nurses of the department. 20 respondents took part in the survey. During the survey, the Martin-Ritchie test "Motivational profile" was used, aimed at identifying the needs and aspirations of each employee, and, thus, to get some idea of his motivational factors. As such, the authors identified 12 needs.
High wages and material rewards.
In good working conditions and a comfortable environment.
In a clear structuring of work, the availability of feedback and information that allows you to judge the results of your work; the need to reduce uncertainty and establish rules and directives.
In social contacts; in the formation and maintenance of long-term stable relationships with a small number of colleagues, while the degree of closeness of relationships, trust is important.
The need for more free time.
In gaining recognition from others, in making others appreciate the merits, achievements and successes of the individual.
In setting challenging goals and achieving them.
In influence and power, the desire to lead others; persistent pursuit of competition and influence.
In variety, change and stimulation; in an effort to avoid routine.
In creativity; desire to be an analytical, thinking worker, open to new ideas.
Improvement, growth and development as a person.
In a sense of being in demand, in an interesting work filled with meaning and meaning with an element of social utility.
The test is based on a comparison of the significance of a number of motivational factors that are important from the point of view of personnel management. Conducting local research in an organization allows us to conclude that certain motivating factors prevail and thus creates a picture of the motivational environment.
The data we have obtained allow us to characterize the motivational environment as follows: high and stable earnings, the ability to work in good conditions, the need for management and colleagues to recognize their merits, achievements and successes are important and valuable for employees (Fig. 1). Among the factors, the stimulation of which will be considered ineffective, employees noted the need for socially useful work, in maintaining and forming long-term relationships with a small circle of colleagues, as well as the need for power, in a clear structuring of work, and the manifestation of a creative non-standard approach (Fig. 2).
Rice. 1. Motivational factors highly rated by employees
With this data in hand, the head nurse can think of and build a reward and incentive system that meets the requirements of efficiency. The presence of non-dominant factors may indicate either sufficient satisfaction in this regard, or a lack of interest in this factor. Meeting the dominant needs will enhance the efficiency and quality of work.
Based on the foregoing, the urology department has a high potential for enhancing the work of nurses. These are incentive payments due to established bonuses for work efficiency, taking into account quality criteria.
For our research, we used the Job Satisfaction Test. This is a standard test used to study the factors that influence motivation, and allows you to identify parameters that are satisfactory or not satisfactory for the organization's employees with the working conditions, the organization of leadership and relations in the work team.
Rice. 2. Non-dominant motivational factors
This test contains 14 statements, each statement can be rated from 1 to 5 points. When assessing the satisfaction with the work of the labor collective, the average values of the indicators are used. In this case, the results are assessed according to the following scale:
15-20 points are quite satisfied with the job
21-32 points satisfied
33-44 points not quite satisfied
45-60 points are not satisfied
over 60 points extremely dissatisfied
The following instructions were offered to the respondents:
Make your choice for each of these statements by ticking the corresponding number.
1 - quite satisfied;
2 - satisfied;
3 - not completely satisfied;
4 - not satisfied;
5 - extremely dissatisfied.
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Statement |
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Your satisfaction with the business where you work |
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Your satisfaction with your physical conditions (heat, cold, noise, etc.) |
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Your job satisfaction |
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Your satisfaction with the teamwork |
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Your satisfaction with your boss's leadership style |
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Your satisfaction with your boss's professional competence |
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Your salary satisfaction in terms of matching your workload |
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Your satisfaction with your salary in comparison with how much is paid for the same job in other enterprises |
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Your satisfaction with career (professional) promotion |
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Your satisfaction with your promotion opportunities |
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Your satisfaction with how you can use your experience and abilities in your work |
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Your satisfaction with the demands of your job on human intelligence |
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Your satisfaction with the length of your working day |
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To what extent would your job satisfaction affect your decision if you were currently looking for a job? |
11 nurses took part in the testing. It should be noted that 7 nurses were absent at the time of the survey (vacation, sick leave, etc.) and one person refused to take part in the survey, explaining his refusal by the fact that nothing would change from his answers. The structure of the admission department includes a trauma center. The nurses of the emergency room were questioned along with the nurses of the admission department. Therefore, the test result can be attributed to the entire structural unit. But immediately I would like to note the fact that those nurses who took part in the ongoing study took the proposed task seriously. They listened carefully to the instructions, and with enthusiasm and thoughtfulness set about the task. This can serve as an indicator of the significance of the test results for them, as an opportunity to express their opinion on these issues. And for us, this can serve as an indicator of the importance of conducting this kind of research.
In the course of the study, we obtained the following result: the average value obtained by dividing the sum of the results for each individual questionnaire by the number of survey participants is 24.5 points, which corresponds to the "satisfied" indicator on the test scale. Thus, in general, the team is satisfied with the conditions and characteristics of work at this enterprise and specifically in the admission department (Fig. 3).
But we were able to see the full picture only by conducting a qualitative analysis of the results obtained. It should be noted that against the background of general satisfaction with the job as a whole, there is a differentiation of results according to individual questionnaires.
So, one person is completely satisfied with all parameters of labor activity, that is, each proposed statement, he assessed at 1 point - "quite satisfied"; four more people rated each statement either at 1 point or at 2 points - "satisfied", that is, they are also satisfied with the conditions that the organization offers them.
In the questionnaires of the rest of the research participants, a negative assessment of working conditions appears.
For three employees, this dissatisfaction manifests itself only once, that is, they rate any parameter at 3 points - “not completely satisfied”. Moreover, these parameters are not related for these survey participants. So, one of them is not satisfied with the length of the working day at the enterprise, the other - the wages, in comparison with other organizations, and the third is not completely satisfied with the requirements of the work to the human intellect. But in general, according to the sum of points (24.25 and 26) obtained as a result of processing the questionnaires of these employees, they belong to the category of employees who are satisfied with the work, that is, we can combine them into the previous group.
Thus, three more questionnaires remain in our field of vision. Immediately we will make a reservation that two of them have total points (27 and 31), corresponding on the key scale to the indicator "satisfied", but since many statements are assessed as not entirely satisfactory, we will consider them in more detail together with the questionnaire, the result of which the sum of points (34) corresponds to the indicator “not quite satisfied”.
The first of the employees (27 points) is not completely satisfied with the coherence of the actions of employees and those parameters that characterize the possibility of using their potential and the possibility of promotion. The second and third employees (31 and 34 points) are also not satisfied with their career advancement and opportunities for their advancement, and one of them is not completely satisfied with the length of the working day and is not satisfied with the salary in comparison with other organizations, while the other is not satisfied with the work in general.
Thus, we can conclude that, along with nurses who are satisfied with their work, there are employees who are not completely satisfied with some parameters of work, although they are generally satisfied with the work, and also one employee is not completely satisfied with the work in general and is not satisfied with some of its parameters. Moreover, it is interesting to note that all of them are not satisfied with, in general, the possibility of promotion. Although in two of them, dissatisfaction with the content of the work predominates (job satisfaction, the use of their experience and abilities), in one employee, against the background of the same dissatisfaction with career advancement, external motivating factors clearly prevail (length of the working day, wages).
So, we can conclude that even with general satisfaction with the work of the entire team, on the basis of a qualitative analysis of the survey results, it is possible to see a number of features of the motivation of individual employees and, with the help of correctly selected management techniques, increase the efficiency of each employee in order to optimize the work of the entire healthcare facility. So, in our case, for two employees, the greatest motivating start will have the opportunities provided for realizing their potential, recognition of their labor contribution and praise for responsible work, as well as the opportunity to see the prospect of development, advancement in the future (this should not be understood as an immediate increase, but putting their candidacy on the reserve list will serve as a powerful impetus in the work, while not obliging the administration to anything). In contrast to the previous example, for an employee oriented to external incentives, external incentives (bonuses, benefits, time off, etc.) will serve as a strong motivational factor, respectively.
Rice. 3. Satisfaction with the work of the admissions nurses
Personnel motivation is an important component in personnel management, as well as a direct way to improve the quality of nursing care with the skillful use of knowledge of the structure of motivation and their application in practice.
The art of management is to clearly understand the needs of a person and create the necessary conditions for their satisfaction.
Conclusion
As a result of our theoretical and practical research based on the analysis of various theories for the study of motivation, we can conclude that the motivational sphere of a person is very complex and heterogeneous.
In modern psychology, there are currently many different theories, whose approaches to the study of the problem of motivation are so different that sometimes they can be called diametrically opposite.
When studying various theories of motivation, when determining the mechanism and structure of the motivational sphere, we came to the conclusion that indeed human motivation is a complex system based on both biological and social elements, therefore, it is necessary to approach the study of human motivation, taking into account this circumstance.
It is also important to note the importance of knowledge about motivation in the management activities of the management of an organization interested in increasing the productivity of its employees, their full return to the enterprise. Understanding and applying in practice the system of motivating one's employees will lead not only to an overall increase in the efficiency of the organization, but also to satisfaction with the work of the employees themselves, and an improvement in the psychological climate. And, as a consequence, again, an increase in the productivity of the organization itself. A competent leader must clearly know that not all employees are motivated equally. Therefore, he must accurately recognize the current motives of each of his employees and try, whenever possible, to satisfy the needs of each.
With knowledge of motivational factors that are highly valued by employees, nursing team leaders can think of and build a reward and incentive system that meets the requirements of efficiency.
As can be seen from our research, even if employees are satisfied with the working conditions, it is possible to single out a number of points based on a qualitative analysis of individual questionnaires, which will allow the manager to improve the efficiency of his management.
So, the scope of application of knowledge on motivation is very extensive, and the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.
Reviewers:
Andrianova E.A., Doctor of Social Sciences, Professor, Head. Department of Philosophy, Humanities and Psychology, Saratov State Medical University named after V.I. Razumovsky Ministry of Health and Social Development of the Russian Federation ", Saratov;
Novokreschenova I.G., MD, DSc, Associate Professor, Head. Department of Economics and Management of Healthcare and Pharmacy, State Educational Institution of Higher Professional Education "Saratov State Medical University named after V.I. Razumovsky Ministry of Health and Social Development of the Russian Federation ", Saratov.
The work was received on 02.02.2012.
Bibliographic reference
Maslyakov V.V., Maslyakov V.V., Levina V.A., Levina V.A., Kuznetsova E.V., Kuznetsova E.V., Lunkova O.A., Lunkova O.A. MOTIVATION IN THE ENVIRONMENT OF NURSES // Fundamental research. - 2012. - No. 3-2. - S. 352-357;URL: http://fundamental-research.ru/ru/article/view?id=29607 (date accessed: 30.10.2019). We bring to your attention the journals published by the "Academy of Natural Sciences"
