Relationship between nurse unit managers' motivation and their

International Research Journal of Basic and Applied Sciences

Vol 4, No. 5;May 2012

Relationship between Nurse Unit Managers' Motivation and Their
Performance Management in Selected Hospital at Makkah Al
Moukarramah, KSA
2

1*2

1

1

HalaY.Sayed Manal M. Ibrahim and

Faculty of Nursing, Umm Al Qura University, Makkah, KSA.
Faculty of Nursing, Menofia University. Faculty of Nursing, Cairo University2 Egypt

Abstract
Background: Nurse unit managers' motivation is a key factor that might
affect the success of an intervention to improve their performance
management. Motivation is the key of a successful organization to
maintain the continuity of the work in a powerful manner and help
organizations to survive. Managers who are motivated to do their work
are enthusiastic, responsible, caring, and eager to improve. Aim.The aim
of this research is to assess the relationship between nurse unit managers'
motivation and their performance management.Design. The research
design of the study is a descriptive correlational research design. Setting.
The study conducted at King Abdul Aziz hospital, King Faisal hospital
and Maternity& Children hospital at MakkahAl Moukarramah. Sample.
Convenient sample was used to collect the data. The total sample of this
study was 60 nurse' unit managers, 22 from King Abdul Aziz hospital, 20
from King Faisal hospital and18 from Maternity& Children hospital.
Tools. There were two tools used to carry out this study.Results. More
than half (58.3%) of the study subjects was in age group (30-39). There
was highly statistical significant correlation between thenurse unit
managers' motivation and their performance management. While, there
was highly statistical significant difference was observed between the
hospitals
regarding
to
motivation
and
performance
management.Conclusion. This study concluded that, the motivation
(drive, control, relationships, challenges, and rewards) in the work
environment at governmental hospitals can be effective method to
motivate the nurse' unit managers as they affect the way of the

34

IRJBAS@SCIENCERECORD.COM


Vol 4, No. 5;May 2012

performance management. Recommendation.Rewards must be
commensurate with the nature of individuals and not with the nature of
the functional cadres, those up can be considered as a good motivational
tool.
Keywords: Nurses' Unit Manager, Motivation, Performance Management.
Introduction:
Motivation is an important factor on which organizational efficiency
depends. It is a process of arousing behavior, sustaining behavior and
channeling behavior in specific course. It explains why some people work
hard and well whereas others perform poorly(Franco et al.2002). In
nursing management, staff needs to be motivated to have quality patient
care, to develop staff efficiency and to reduce absenteeism. A nursing
superintendent must reward the good nursing care given by staff nurse so
that she is motivated to work harder (Dieleman, et al. 2006)(Ibrahim,et
al. 2003).
Performance management is a participative process in which the
staff member and unit manager share responsibility for the development
of an action plan,by participating effectively in the performance
management plan.Staff members have an opportunity to gain personal
recognition and development.Performance management recognizes that
the effective operation of the unit depends on the knowledge, skills and
performance of its staff. It is working in a way that will enable continuous
performance improvement in line with the unit direction, and will at the
same time increase staff innovation and job satisfaction(Boyett et al.
2000).

35



Vol 4, No. 5;May 2012

The unit managers' duties include providing communication
between the nursing staff, medical staff, administrative staff and any
governing bodies within the organization. The nurse administrators must
be familiar with the specifics of the health care industry and be able to
effectively translate a variety of ideas to others within the organization
that may not be as well versed in the field (Boyett et al. 2000 &Howell,
2000).

An organization needs to influence satisfiers through performance
management the "measuring, monitoring and enhancing the performance
of staff", using a range of human resources management (HRM) tools
such as: job descriptions, supervision, performance appraisals, continuous
education, rewards and career development(Martinez, 2001 & Family
Planning Management Development Technical Unit, 1998).
Nurse managers play a vital role in health care. They are the
essence of any health care system. Their chief responsibilities include
taking care. Their ultimate goal is implementation of policies that ensures
care, compassion and dedicated health care services(Stewart, 2004).
Significance of the study
Motivation can help improve unit managers' performance, reduce the
chances of low manager morale, encourage teamwork and instill a
positive attitude during challenging times. Unit managers' with a high
level of motivation typically work harder and provide high-quality of
care, maintain a high level of productivity and overcome common

36



Vol 4, No. 5;May 2012

workplace challenges with ease, this helps the unit reach its objectives
and improve operations overall.
Aim of the study
This study aimed to:
Assess the relationship between nurse unit managers' motivation and their
performance management.
• Research Question
What is the relationship between nurse unit managers' motivation and
their performance management?
Subjects and methods
Research Design
The research design of the study is a descriptive correlational design.

Setting
The present study was conducted in three hospitals at Makkah Al
Mokarama, Saudi Arabia. The first setting is the King Abdul-Aziz
hospital. This hospital was built in 1376 AH, located in the AL-Zaher
street; it is considered one of the oldest hospitals in Makkah, composed of
eleven units and wards as follow: renal dialysis, OPD, ER, OR, medical
male, medical female, surgical male, surgical female, orthopedics, ICU
and day care unit.
The second setting is the King Faisal hospital is one of the medical
edifices in the Holy City which provides therapeutic services at all levels.
This hospital was built in 1384 AH. Composed of ten units and wards as

37



Vol 4, No. 5;May 2012

follow: OPD, ER, OR, ICU, surgical male, surgical female, medical male,
medical female, renal dialysis and viruses & isolation unit.
The third setting is the Maternity& Children hospital which is the first
governmental hospital in KSA for treating the maternity and children
diseases. This hospital was built in 1372 AH. It's in Jarwal region,
composed of four floor with 300 bed capacity and eleven units and wards
as follow: gynecology ER, pediatric ER, OPD, anti natal ward, delivery
room, OR, nursery, surgical ward, post natal ward, pediatric ward and
gynecology ward.
Sample
Convenient sample was used to collect the data. The total sample
of this study was 60 nurse unit managers, 18 from Maternity& Children
hospital, 22 from King Abdul Aziz hospital and 20 from King Faisal
hospital. The unit managers fall into two categories: a bachelor degree in
nursing and a diploma in nursing. The number of bachelor was 14, and
the number of diploma was 46 unit managers.
Tools of data collection
In order to fulfill the research aim, two tools were used to collect
data. First, motivation tool, which was developed by Smith (1988).This
tool aimed at assessing the unit managers’ motivation. The Questionnaire
is consists of 35 items: divided to 5 categories as follow: drive (10 items),
control (6 items), relationships (5 items), challenge (11 items) and
rewards (3 items).
Second, performance management tool, which was developed by
Family

38

Planning

Management

Development

Technical



Vol 4, No. 5;May 2012

Unit(1998).The tool aimed at assessing unit managers' performance
management. It consists of 45 items: divided to 5 categories as follow:
departmental responsibilities (7 items), nursing process / patient care
responsibilities (15 items), continuing education (5 items), equipment (6
items), and attitude (12 items).The tool had translated into Arabic to
make it easier for the diploma nurses who are not fluent in English.
Responses to the questions of two tools were answered by “agree”,
“neutral”, and “disagree”; scored by using a likert scale from1 to 3
respectively.
Statistical Analysis
Data entry and analysis were done using Statistical Package for the
Social Sciences “SPSS” program, version 13. Data were presented using
descriptive statistics in the form of frequencies and percentages for
qualitative variables and means and standard deviations for quantitative
variables. ANOVA analysis was used for assessment of the relationships
of the study variables among three hospitals. Chi-Square analysis was
used for assessment of the relationships among qualitative variables. Ttest was used to test significant. Statistical significance was considered at
p-value ≤ 0.05.
Pilot study
After review of the tools by experts and its approval, a pilot study
was carried out before starting the actual data collection. The purpose of
the pilot study was to ascertain the clarity, and applicability of the study
tools, and to identify the obstacles and problems that may be encountered
during data collection. It also helped to estimate the time needed to fill in

39



Vol 4, No. 5;May 2012

the questionnaire. Based on the results of the pilot study, modifications,
clarifications, omissions, and rearrangement of some questions were
done. The pilot study was done on 5 assistant head nurses and 5 unit
managers working in different wards/units on King Faisal hospital, King
Abdul- Aziz hospital and Maternity& Children hospital and those were
included in the total study subjects after reassessment and modification of
the tools.
Ethical Considerations and Procedure
Before any attempt to collect data, a formal letter was issued from
the Faculty of Nursing Umm Al Qura University, to obtain an official
approval from the administrators of the hospitals where the data were
collected to conduct the study. The letter identified the researchers, the
title and aim of the research. The data collection phase of the study was
carried out in one month (May 2011). The researcher introduced herself
to the respondents, and explained the aim of the study to the unit
managers in the study setting. Each participant was notified about the
right to refuse to participate in the study before taking her verbal consent.
Anonymity and confidentiality of the information gathered was ensured.
Then, the study tools was distributed to them, during morning shift for
one day/week, with instructions about its filling and collected on the same
day. This was repeated in each unit/ward of the study hospitals. The
researcher was present most of the time to clarify any ambiguity. The
time taken for every questionnaire to be completed was about 30-50
minutes for each nurse unit manager.
Results

40



Vol 4, No. 5;May 2012

Table (1):Distribution of demographic variables and general
characteristics of the study subjects.
Variables
Age
20-29
30-39
40-49
50-60
Gender
Male
Female
Marital Status
Unmarried
Married
Level of Education
Diploma
Bachelor
Experience Years
1-10
11-20
20Training Courses
Yes
No
Number
of
training
courses
1-20
21-40
41-

41

No = 60
NO
10
35
10
5
NO
4
56
NO
29
31
NO
46
14
NO
30
20
10
NO
60
0
NO

%
16.7
58.3
16.7
8.3
%
6.7
93.3
%
48.3
51.7
%
76.7
23.3
%
50
33.3
16.7
%
100
0
%

46
10
4

76.7
16.6
6.7



Vol 4, No. 5;May 2012

Table (1) illustrate that, more than half (58.3%) of the study subjects
were in age group (30-39), while the least frequent (8.3%) of them were
in the age group (50-60). Regarding to the gender of the study subjects,
the highest percentage (93.3%) was female, while the lowest percentage
(6.7%) was male. Nearly half (51.7%) of the study subjects were married,
while unmarried were 48.3%. According to the level of education, more
than three fourths (76.7%) of the study subjects were diploma nurse.
While, the rest (23.3%) of them were bachelor degree. In relation to years
of experience for the study subjects was found that 50% of them had
experience ranging from (1-10) years, while the least percentage (16.7%)
had experience of more than 20 years. Also, 76.6% of the study subjects
had received training courses and hold a number of training courses
ranging between (1-20) , compared to 6.7% of them had training courses
more than 40 courses.
Table (2):Percentage distribution of the total study subjects
according to motivation categories
Motivation

Agree

Neutral

Disagree

No

%

No

%

No

%

Drive

52

86.7

3

5

5

8.3

Control

56

93.3

3

5

1

1.7

Relationships

51

85

8

13.3

1

1.7

Challenges

55

91.7

5

8.3

0

0

Rewards

46

76.7

4

6.6

10

16.7

Total

42

86.68

7.64

5.68



Vol 4, No. 5;May 2012

Table (2) showed that, the highest response (93.3%) was observed on
control category, followed by challenges category (91.7%), drive
(86.7%), relationships (85%) and rewards (76.7%). While there was
disagree response regarding to all items except the challenges among the
minority of the study subjects.
Table (3):Percentage distribution of the total study subjects
according to performance management categories
Performance Management

Agree

Neutral

disagree

No

%

No

%

No

%

57

95

3

5

0

0.00

57

95

2

3.3

1

1.7

Continuing education

57

95

3

5

0

0.00

Equipment

60

100

0

0.00

0

0.00

Attitude

58

96.7

2

3.3

0

0.00

Departmental responsibilities
Nursing process / Patient. care
responsibilities

Totalperformance management

96.34

3.32

0.34

Table (3) illustrated that, the equipment category was more item
supported by (100%) agree response, followed by attitude category
(96.7%). Moreover, the departmental responsibilities, nursing process /
pt. care responsibilities, and continuing education categories were equal
percent (95%). While disagree response was observed regarding to all
items except nursing process / pt. care responsibilities as reported by
1.7% of study subjects.

43



Vol 4, No. 5;May 2012

Table(4):Relationship between demographic data of the study
subjects and their motivation andperformance management

Variables


Motivation

F

p

F

P

Age

4.96

0.002**

0.56

0.80

Years of experience

2.96

0.02*

1.30

0.26

No. of training courses

2.53

0.05*

2.12

0.05*

*Statistically significant at level ≤ 0.05.
**Statistically significant at level 0.01.
***Statistically significant at level 0.001.

Table (4) clarified that, there was highly statistical significant
relationship between unit managers' age and their performance
management (p = 0.002). Also, there was a statistical significant
relationship between unit managers' years of experience, number of
training courses and their performance management (p = 0.02, 0.05)
respectively. While, there was no statistical significant relationship
between unit managers' motivation and their demographic data except
with number of training courses (p = 0.05).
Table (5):Relationship between demographic data of the study
subjects and their motivation and performance management
Variables
Gender

44

p
χ2
12.85
0.012**

Motivation
P
χ
60.00
0.000***
2



Vol 4, No. 5;May 2012

Marital Status

12.15

0.016**

39.06

0.000***

Level of education

30.47

0.000***

42.03

0.000***

Table (5):illustrated that, there was highly statistical significant
relationship between unit managers' gender, marital status and level of
education and their performance management (p= 0.012, 0.016, and
0.000) respectively. Also, there was highly statistical significant
relationship between unit managers' gender, marital status and level of
education and their motivation (p= 0.000, 0.000, and 0.000)respectively.
Table (6):Relationship between nurse unit managers' performance
management and their motivation

Motivation

χ2

Drive

22.50

0.000***

Control

36.40

0.000***

Relationship

46.93

0.000***

Challenges

45.66

0.000***

Rewards

10.30

0.006**

Total

45

p

29.00

0.000***



Vol 4, No. 5;May 2012

Table (6) clarified that, there was highly statistical significant
relationship between unit managers' performance management and all
categories of their motivation (drive, control, relationships, and
challenge) where p value of chi-square = 0.000, except reward category
where p value = 0.006. Moreover, there was highly statistical significant
relationship between unit managers' performance management and their
total motivation (p = 0.000).

Table (7):Total mean scoresof nurse unit managers' motivation and
their performance management regarding to the hospitals

King Abdul
Aziz hospital

Variables

Maternity&
Children
hospital

King Faisal
hospital

M

Performance
management

M

S.D

M

S.D

42.45

Motivation

S.D
5.15

41.00

4.48

41

4.07 18.90 0.015

45.77

2.24

45.38

2.11

45.85 2.34

t

29

p

0.000

Table (7)showed that, the mean and standard deviation was
observed regarding to unit managers' motivation in hospitals as follow:
King Abdul-Aziz hospital (M=42.45, S.D=5.15), Maternity& Children
hospital (M=41.00, S.D=4.48) and King Faisal hospital (M=41.00,
S.D=4.07). Also, the mean and standard deviation were observed

46



Vol 4, No. 5;May 2012

regarding to unit managers' performance management in hospital as
follow: King Faisal hospital (M=45.85, S.D=2.34), King Abdul Aziz
hospital (M=45.77, S.D=2.24) and Maternity& Children hospital
(M=45.38, S.D=2.11).While, there was highly statistical significant
difference was observed between the hospitals regarding to unit
managers' motivation and their performance management ( χ 2 =18.90,
p=0.015) ( χ 2 =29, p=0.000) respectively.

Discussion:
The use of positive motivational techniques must be consistent and
timely in order to be effective. Proper use of positive motivation is
critical for

nursing managers in today's constantly changing health

environment. Hospitals with effective motivational programs continue to
have the extra edge needed to stayahead of their competitors(Abdel
Hamed, 2002).The aim of the present study was to assess the relationship
between nurse unit managers' motivation and their performance
management.

In the present study, the highest percentage (93.3%) of participants
were female, while the lowest percentage was (6.7%) of them were male,
because the all most of the subjects were female. The present study
findings revealed that, more than half of nurses had diploma, this may be
because nursing diploma program was the only source of nursing
graduate at Makkah Al Mukarama till the recent establishment of faculty

47



Vol 4, No. 5;May 2012

of nursing at Umm Al Qura University at 2006. The high percentages of
the nurses were married ,because most of them are in age group (30-39).

The finding of the current study,revealed that there was statistical
significant difference between unit managers' number of training courses
and their motivation. This finding is consistent withCapozzoli(1998) who
found that a motivating environment may produce satisfiedemployees,
which in turn may make many employees happy. A motivating
environment exists with conditions of high standards, clear objectives,
adequate training, effective leadership, rewards that employees value, and
adequate working conditions. In the same line,
Kamery(2004) mentioned that one of motivators used by various
organizations

include

educational

trainings

programs

and

staff

development.
Also, Dieleman, etal. (2006) they found that, the main motivators
of health workers were related to responsibility, training and recognition,
next to salary. These can be influenced by performance management (job
descriptions, supervisions, continuous education and performance
appraisal).
All of these represent long-term programs thatare specifically
designed to increase worker satisfaction and effectiveness.So, increasing
number of attending training courses leads to gain new knowledge and
this can lead to gain power and motivation(Bessell, et al. 2006).

48



Vol 4, No. 5;May 2012

The findings of this study indicated that there was a statistical
significant difference between years of experience and performance
management, this findingis consistent with Peiyulin (2007)who found
that the employees that had been working more than six years
foundinteresting work more important than the employees that had only
beenworking for less than five years. The reason for this could be that
theemployees that had been working for more than six years felt that they
had enough job security, wages that they thought were good enough,
andenough job appreciation from the managers, and were also satisfied
with theworking conditions and loyalty from the company(Hiram, 2003).

In the finding of present study clarified that , there was a highly
statistical significant relationship between gender and motivation. This
finding was supported by Peiyulin (2007)who found that, there were
significant difference between male and female employees regarding
motivation according to whether the wage were good and whether the
manager helped the employees with their personal problems. Majority of
male employees were highly motivated by good wage.

The finding of the current study indicated that, there was a highly
statistical significant difference between rewards and unit managers'
performance management. When rewards are given to those who achieve
high performance, they can become an important instrument to encourage
the continuance of the desired behavior.The relationship between the
employees’

49

performance

and

organizationalrewards

is



Vol 4, No. 5;May 2012

important(Herzberg, 2003). Managers must make sure that the
employees believe that if theyget a performance appraisal, it will lead to
organizational rewards. Many employees seethis relationship as weak
because the organization does not give rewards just on theirperformance,
so there is a lack of motivation (Robbins, 2003).

The finding of the present study revealed that there was a highly
statistical significant relationship between unit managers' motivation and
their performance management, these finding were supported by
Chowdhury (2007)who found that,unit managers engaged in positive
motivational

behaviorsthat

managers'

intrinsic

motivations

were

increased, which turn, increased their performance.

Positive Achievement motivational leaders are those whoinspire
followers to transcend their self-interests and whoare capable of having a
profound and extraordinary effecton followers (Robbins, 2003).
Demonstrating positivemotivational behavior becomes instrumental in
motivatingemployee work performance (Mumford et al., 2002;
Robbins, 2003;Chowdhury, 2006& 2004).

Moreover, Motivation is a process of arousing and sustaining
goaldirectedbehaviorof several work motivation theories,both extrinsic
and intrinsic motivation plays an importantrole in influencing employee
work performance(Chowdhury,2007).

50



Vol 4, No. 5;May 2012

Conclusion:
There was highly statistical significant difference was observed among
the hospitals regarding to motivation and performance management. All
these motivation (drive, control, relationships, challenges, and rewards)
imply that creating a positive environment through encouragement and
positive reinforcement of nurse unit managers will improve work
motivation and performance.

Recommendations:
The present study recommended that:
1- Establishment of training courses and workshops on the importance of
motivate the nurses' unit manager in hospitals to improve and raise
the level of performance management and their skills.
2-Further researches are needed regarding to the factors affect the nurse
unit managers' motivation and their performance management.
3- Administrative directives by the heads of departments must be
participatory, effective and should be moving away from strict orders
to be replaced by the implementation of the action team.
4- The relationship in the workplace should be used well to obtain the
optimum level performance.
Corresponding author
ManalMoussa Ibrahim Moussa
Associate Professor of Nursing Management
Faculty of nursing, Umm Al Qura University, KSA.
Nursing Administration Department, Faculty of Nursing, Menofia
University, Egypt.

51



Vol 4, No. 5;May 2012

mmmoussa66@yahoo.com
References
Abdel Hamed, M.(2002).The relationship between motivation and
satisfaction among nurses.Master thesis in nursing service
administration, Faculty of Nursing, Zagazig University.
-Bessell, I.,Dicks,B.,Wysocki, A &Kepner, K (2008). Understanding
Motivation: An Effective Tool for Managers, a series of the Food and
Resource Economics Department, Florida Cooperative Extension
Service, Institute of Food and Agricultural Sciences, University of
Florida. website at http://edis.ifas.ufl.edu.
-Boyett, H. & Jimmie T. (2000). Worldclass advice on managing and
motivating people.Boyett and Associates.Available on the World Wide
Web at http://www.jboyett.com/managing1.htm. Date visited, March
25, 2002.
-Capozzoli, T. (1998). Creating a motivating environment for employees.
New York: McGraw-Hill Inc., 16.
-Chowdhury , M. (2007). Enhancing motivation and work performance of
thesalespeople: the impact of supervisors’ behavior, African Journal
of Business Management.Vol. 1 (9), pp. 238-243.
-Chowdhury M (2006). “Pygmalion in Sales: The Influence of
Supervisors’ Expectations on Salespersons’ Self-Expectations and
their Work Evaluations”, J. Bus. Public Aff. 1(1): 1-12.
-Chowdhury M (2004). “Gender and Race in Salespersons Evaluations:
A Case Study of a Multicultural Sales force. J. Bus. Behav. Sci. 12,
(1); 52-60.

52



Vol 4, No. 5;May 2012

-Dieleman, M, Toonen, J., Touré, H& Martineau, T (2006). The match
between motivation and performance management of health sector
workers in Mali, Human Resources for Health, 4:2 pp. 1-7.
-Family Planning Management Development Technical Unit, (1998) The
Health and Family Planning Manager's Toolkit. Boston,
Massachusetts, USA: Management Sciences for Health; 1998.
Performancemanagement
tool.http://erc.msh.org/newpages/english/toolkit/pmt.pdf.
-Franco LM, Bennett S, KanferR..(2002).Health sector reform and
publicsector health worker motivation a conceptual framework.Social
Science and Medicine, 54:1255–1266.
- Hiram, A.(2003).Motivational Management
http://books.google.com.sa/books?id=00txA_FQoQsC&printsec=fron
tcover&hl=ar&source=gbs_ge_summary_r&cad=0#v=onepage&q&f
=false.
-Howell H. (2000). Motivating and appreciating yourstaff. A Catanzaro
and Associates, Inc. website availableon the World Wide Web at
http://v-p-c.com/catanzaro/mgtinfo/newsletter/spring2000/
motivat.htm. Date visited, March 25, 2002.
-Herzberg F. (2003). One more time: how do you motivate employees?
Harvard Business Review. 81:87–96.
- Ibrahim M.,Abd EL-Whaab E. &Abd EL-Fattah M. (2003) Impact of
nurses’ motivation on their productivity in centralized VS.
decentralized organization structers.Nursing Faculty Conference - Ain
Shams University-Egypt.

53



Vol 4, No. 5;May 2012

-Kamery. R. (2004).Employee motivation as it relates toeffectiveness,
efficiency, productivity,and performance. Proceedings of the
Academy of Legal, Ethical and Regulatory Issues, Volume 8, Number
2. pp. 139-143.
-Martinez J. (2001). Assessing Quality, Outcome and Performance
Management. Geneva: World Health Organization; 2001.
-Mumford M, Scott M, Gaddis B, Strange, M (2002). “Leading
creative people: Orchestrating expertise and relationships. The
Leadersh. Q. 13: 705-750
-Peiyulin,S (2007). The Correlation between Management and
Employee Motivation in Sasol Polypropylene, Business, South Africa pp.
190-195.
-Robbins P (2003). Organ.Behav. 10th edition, Prentice hall, NJ.
-SmithJ. Motivation questionnaire.(1988).
http://www.docstoc.com/docs/42147926/motivation-questionnaire.
-Stewart, D (2004).Goals & Objectives for Nurse Managers
eHow, pp. 1-3.

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