Nursing Management Process – Directing

– In planning and organizing the manager provides an environment that leads to getting the work done.

In directing: the manager sets those plans into action with the ultimate goal is attainment of organizational goals.


– Motivation =The level and direction

of EFFORT expended at work.

– Motivation: Is a set of forces that energizes, directs, and sustains behavior.

– In order for the nurse manager to guide and direct staff members, he must first understand the nature of human behavior and the reasons behind that behavior

– To understand another person, you must know how he feels about himself. Personal self-image will influence behavior.

– A person’s self concept is acquired from childhood experiences and from the feedback he receives for his achievements.

– A person’s behavior is purposeful, and the manager needs to be perceptive in understanding why staff members are behaving as they are.

– The successful manager learns the reasons behind the behavior and takes the necessary steps to correct undesirable behavior.

– Individuals attempts to fulfill their wants, drives and needs.

– The word motive implies action to satisfy a need.


To understand this subject, let us explore the following questions:

1- Why are some managers / employees more motivated than others?

2- How do motivated managers affect their subordinates?

3- What should the manager do with the employee who is demotivated?

– One American saying "How can I soar with eagles when I work with turkeys?”

– This saying is usually followed by: "Why does not management do something about the turkeys?"

– Managers can’t directly motivate subordinates, but they can create an environment that maximize the development of human potentials.


Some agents that play a role in increasing motivation:

a- manager’s support.
b- Collegial influence.
c- Interaction of personalities in the work group.

– The manager must identify those agents and strengthen them.
– All human beings have needs which motivates them. It is the leader who focus on the needs and wants of individual workers and employs motivational strategies appropriate for each person and situation (psychological, economical, social).

– The leader is a role model, listener, supporter and encourager for motivated employees.

– The leader manager must create a work environment that meets both organizational and individual goals / needs.

– Adequate tension must be created to maintain productivity while encouraging subordinates job satisfaction. Thus, the worker can achieve personal goals by achieving organizational goals.


Definition of Motivation

Motivation =The level and direction of EFFORT expended at work.

– Motivation: Is a set of forces that energizes, directs, and sustains behavior.

– It is the behavior individual takes to satisfy unmet needs.

– It is the willingness to put effort into achieving a goal or reward in order to decrease the tension caused by the need.

Motivation is defined as:

– A state of feeling or thinking in which one is energized or aroused to perform a task or engage in particular behavior.

This definition focuses on motivation as emotional or cognitive state that is independent of action.


Types of motivation:

1- Intrinsic motivation:

– Comes from within the individual, driving him to be productive.

– To be intrinsically motivated at work, the nurse must value job performance and productivity.

– Internal Motivation” forces” : are forces that come from the person, the so-called ‘push’

The intrinsic motivation to achieve is directly related to:

a. Person’s level of aspiration.

b. Person’s believe that improved performance lead to outcomes congruent with their value.

c. Increased effort will lead to improved performance and increase productivity and thus, the required energy expenditure will be worth the cost.


2- Extrinsic motivation:

– Enhanced by job environment or external rewards.

– The reward occurs after the work has been completed.


Motivation can be:

Intrinsic :Relating to the individual him/herself, intangible e.g. sense of achievement, challenge

Extrinsic : External to the individual, out of their control e.g. salary, promotion conditions of work


Why People Do the Things They Do?

– Curiosity – desire to learn

– Food – desire to eat

– Honor – desire to act morally

– Rejection – fear of social rejection

– Exercise – desire for physical activity

– Order – desire for organization

– Independence – desire for autonomy

– Vengeance – desire to retaliate

– Social contact – desire for company

– Family – desire to be with family

– Aversion – desire to avoid pain

– Citizenship – desire to serve public

– Power – Desire to influence others

– Social prestige – desire for attention

Source: Steven Reiss and Susan avercamp, Psychological Assessment (June, 1998).

– Although all individuals are intrinsically motivated to some degree, it is unrealistic for organization to assume that all workers have adequate levels of intrinsic motivation to meet organizational goals.

THUS, organization must provide a climate that stimulates both extrinsic and intrinsic drives.

– Because every human being is unique and have different needs, so every person is motivated differently.


Basic Motivational Concepts

– Reward : a work outcome of positive value to the individual.

– Extrinsic rewards—valued outcomes given to someone by another person.

– Intrinsic rewards—valued outcomes that occur naturally as a person works on a task.


Motivation Theories

1- Content Theories

2- Process Theories

3- Reinforcement Theory

4- Theory Z : Ouchi

Content theories

– are concerned with what energize behavior.


Types of Content Theories

– Hierarchy of needs theory (Maslow)

– ERG theory

– Two-factor theory

– Acquired needs theory




Maslow’s Hierarchy of Human Needs

Higher-Order Needs

Self-actualization needs : self-fulfilment; personal development; self-realisation; sense of self-achievement

Esteem Needs: self-worth, self-esteem; respect from others; authority and influence over others

Lower-Order Needs

– Social needs: The need to be loved and to love; need to feel wanted and appreciated;

– Safety needs: security at home; security of work and wage; comfortable living conditions

– Physiological Needs: the need for food, shelter, clothing, heat.


Opportunities of Satisfaction in Maslow’s Hierarchy of Human Needs

What satisfies higher-order needs?


What satisfies lower-order needs?




– Managers can’t apply Maslow’s hierarchy mechanistically, it is unreasonable to include that unmet needs do motivate most employees most of the time.

– Organizations should provide employees with wages sufficient for food and shelter, reasonable protection of job, health and safety, a satisfactory physical and social environment at work and rewards or recognition that reinforce individual esteem.

– Managers should also recognize and support growth needs by providing opportunities for career advancement, encouraging self development creating environment that individuals explore their individual talents and dreams.

– people needs change overtime, the institute manager will recognize what specific needs are important to motivate each individual.


Alderfer’s ERG Theory

Collapses Maslow’s five need theories into three



1. Existence needs

– Sustaining existence and survival motivates us

– Correlates with Maslow’s physiological and safety needs

2. Relatedness needs

– We are motivated by our relationships at workwith colleagues, boss etc.

– Corresponds with Maslow’s social needs

2. Growth needs

– We are motivated to develop out potential

– Corresponds with Maslow’s self-esteem andself-actualisation levels


Herzberg’s Two-Factor Principles

1- Motivators or Satisfiers

– Result in employees either being satisfied or not satisfied “recognition, the work itself, responsibility and achievement, Advancement, Personal growth “

– since their presence increase job satisfaction and motivation but their absence does not lead to dissatisfaction.

– These are the factors which motivate people to work harder

2- Hygiene Factors

– Result in employees either being dissatisfied or not satisfied but not Necessarily motivated

– Hygiene factors of themselves do not motivate higher performance but eliminate dissatisfaction

Hygiene factors Dissatisfiers:

or were negative or absent dissatisfaction results. These factors are related to the work environment and involved company policy and administration, salary, interpersonal relation, and working conditions.

– Hygiene factors prevent dissatisfaction but do not lead to satisfaction and motivation


Herzberg’s Two-Factor Principles



McClelland’s Acquired Needs Theory

Need for Achievement

Desire to do something better or more efficiently, to solve problems, or to master complex tasks.

Need for Power

Desire to control other persons, to influence their behavior, or to be responsible for other people. Personal power versus social power.

Need for Affiliation

Desire to establish and maintain friendly and warm relations with other persons.


Comparison of Motivation Theories



Process Theories

– Process theories explore why employees choose particular actions to achieve their goals

– Process theories: focus on how behavior is energized


Types of Process Theories

-  Equity Theory

– Expectancy Theory

– Goal-Setting Theory


Equity Theory

– Developed by J. Stacy Adams.

– When people believe that they have been treated unfairly in comparison to others, they try to eliminate the discomfort and restore a perceived sense of equity to the situation.

  • Perceived inequity.
  • Perceived equity.

– Relationships are fair when people perceive that their outcome (e.g. pay) is proportionate to their perceived contribution or inputs (e.g. task performance).

– People evaluate fairness by comparing themselves to others, in other words people contrast their perceived inputs and outcomes with their perceptions of others inputs and outcomes. Individuals experience tension if the ration is seen as unequal.


Adams proposes two kinds of inequity.

A- Underpayment:

– Refers to the case when someone perceives that he / she is receiving fewer rewards from job than another person making comparable contribution.

B- Overpayment:

Occurs when someone perceives that he / she is receiving more rewards than another person making comparable contribution.

Adams also proposed that

– people are motivated to reduce tension that result from perceived inequity.

– The greater the perceived inequity tension, the greater the need for motivation is to reduce it.


Expectancy Theory

– Developed by Victor Vroom.

– Key expectancy theory variables:

  • Expectancy – belief that working hard will result in desired level of performance.
  • Instrumentality – belief that successful performance will be followed by rewards.
  • Valence – value a person assigns to rewards and other work related outcomes.

Goal-Setting Theory

– Properly set and well-managed task goals

can be highly motivating.

– Motivational effects of task goals:

  • Provide direction to people in their work.
  • Clarify performance expectations.
  • Establish a frame of reference for feedback.
  • Provide a foundation for behavioral self-management


How to Set Goals at Work?

  • Set specific goals
  • Set challenging goals
  • Build goal acceptance and commitment
  • Clarify goal priorities
  • Provide feedback on goal accomplishment
  • Reward goal accomplishment


Reinforcement Theory of Motivation “Operant conditioning”

– Developed by B.F. Skinner.

– Applies law of effect to control behavior by manipulating its consequences.


Reinforcement Theory of Motivation

– Reinforcement theory focuses on the impact of external environmental consequences on behavior.

– Law of effect — impact of type of consequence on future behavior.

– Skinner’s research on operant conditioning and behavior modification demonstrated that people can be conditioned to behave in a certain way based on a consistent reward or punishment.

– Behavior that is rewarded will be repeated and behavior that is punished will be decreased or stopped.


Positive Reinforcement

Positive Reinforcement:

Is an increase in the likelihood of a behavior due to the addition of a re-enforcer after a behavior.

Negative Reinforcement

Increases the frequency of a behavior through the contingent removal of an unpleasant consequence.


Operant Conditioning Strategies

Punishment: Decreases the frequency of a behavior through the contingent presentation of an unpleasant consequence.

Extinction: Is the withholding of reinforcement for a previously reinforced behavior in order to eliminate that behavior. Ignored behavior.

– McGrogers’ Theory X and Theory Y:Douglas McRogers developed this theory in (1966).

Theory X assumes that:

a- Most people would rather be directed than assume responsibility for creative problem solving.

b- They find work distasteful and are motivated primarily by physical and security needs

c- They must be managed through close supervision, seek rewards in money and other fringe benefits and punishment.


Theory Y assumes that:

a- People are basically reliable and naturally enjoy work if conditions are favorable.

b- Can be self-directed.

c- Can be creative and welcome opportunities make contributions.

d- Can be motivated by exposure to less external control and progressively more self-control.


– Broadening individual responsibility is beneficial both to workers and t the organization for which they work.

– Giving people the opportunity to grow and mature in their job helps them satisfy more than just physiological and safety needs. It motivates them to seek higher level needs, to utilize more of their

– potential, to be more productive on the job and thus to achieve more of their own and organizational needs (Ellis & Hartley, 1995).


How can a nurse manager create a motivating climate?

The nurse manager can create a motivating climate by:
A- Positive reinforcement:
– The most powerful motivator a manager can use.

Some approaches to effective reinforcement includes:
1- Positive reinforcement must be specific or relevant to a particular performance

2- Positive reinforcement must have immediacy by occurrence as close to the event as possible.
3- The reward feedback must be achievable.

4- Rewards should be unpredictable and intermittent.. if rewards are given routinely they tend to lose their value.

B- By being a positive and enthusiastic role model in the clinical setting:

– Employees frequently gauge their job security and their employer’s satisfaction with job performance by the expression that see on their manager’s face.
C- Mentor future managers:
KOTTER (1985) stated that "managers must be mentors, sponsors, coaches and role model, if new employees are to succeed in their roles.


Strategies to create a motivating climate:

– In addition to previous points, the manager must use the following strategies to create a motivating climate:

1- Have clear expectations from nurses and communicate these expectations effectively.

2- Be fair and consistent in dealing with all nurses.

3- Be a firm decision-maker … not hesitated.

4- Develop the concept of teamwork, develop group goals and projects that will build a team spirit.

5- Integrate the staff needs and wants with organizational interests and purposes.

6- Know the uniqueness of each nurse (as a person), and let each one understand that you know his uniqueness.

7- Remove traditional blocks between nurses and the work to be done.
8- Provide experiences that challenge or (stretch) the nurses and allow opportunity for growth.

9- When appropriate, let subordinates participate in decision-making.
10- Give nurses recognition and credit.
11- Make sure nurses understand the reasons behind decisions and actions.
12- Reward desirable behavior.
13- Create a trustful and helping relationship with employees.

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