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Motivation is a state of mind, an attitude, or a way of thinking that inspires individuals to go above and beyond rather than simply performing a job or task well.1 Being motivated also results in better work performance.2 Individuals are motivated by both extrinsic or intrinsic rewards. However, extrinsic rewards can only go so far. Without the internal component, a person’s level of motivation is not like- ly to last.

Motivation is derived from internal urges—needs, desires, wishes, drives, ideas, and emotions—that prompt a person to action and result in specific behaviors.3 Although external stimuli can increase the level of motivation, it is the inner urge that actu- ally motivates a person.4 Motivation is the driving force behind a person’s intensity, direction, and persistence toward attaining a goal.5

From a manager’s perspective, motivation results in the employee acting in a manner that helps achieve departmental and organizational aims. It is to the manager’s advantage to understand employ- ees’ personal desires and needs and help them meet those needs while working better and more effectively.

Motivation is very complex and can be difficult to understand when predicting behavior. First,

Motivation What makes you tick?

By Debra Dunn, MSN, MBA, RN, CNOR

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40 OR Nurse 2015 March www.ORNurseJournal.com

Motivation: What makes you tick?

motivation is highly situational: what motivates one person in one situation may not necessarily motivate that person in a different situation. Second, people react differently to the same motivational factors. Third, people may not even be aware of what moti- vates them, which happens when motivation occurs at the subconscious level. Finally, motivation can be positive with a strong level of commitment or nega- tive such as when the person is motivated to do “just enough” to be adherent but is not very engaged.3,6 Although some individuals may be more motivated than others, everyone is motivated to some extent.6

Nurses focus on the delivery of effective and effi- cient patient care with excellent quality outcomes; however, these outcomes are directly related to a nurse’s willingness to apply knowledge and skills in his or her work. Research shows enhanced patient outcomes when employees are motivated to per- form at their highest levels.5,7

Incentives: Extrinsic and intrinsic factors Understanding motivational factors is important to design systems with the correct incentives in place to encourage motivation.8 It is important to recognize that motivation is not the same as incentive. With incentives, the same input is expected to yield great- er outputs. With motivation, more inputs are needed to change the outputs of work performance, an employee’s attitude, and behavior. Incentives are external in nature, while motivation is the expression of an individual’s inner, personal needs.3

Intrinsic motivation is an internal sense of satisfac- tion due to some sort of achievement, such as performing a job well. This internal desire or drive is expressed as behavior designed to accomplish a goal. Extrinsic motivation is the same as intrinsic motiva- tion except that the motivator is external to the indi- vidual. An example of a combined effect is when someone is recognized for a job well done (extrinsic), resulting in an increased sense of self-worth, self- esteem, and self-confidence (intrinsic). This symbiotic reaction increases the likelihood the employee will be willing to take on new challenges and contribute new ideas in the future. Extrinsic rewards can only go so far when they do not match an employee’s internal needs. For example, compensation is rarely the number one motivating factor that gets an indi- vidual out of bed in the morning to go to work.2 Creating a type of environment where employees

can grow and contribute is more of a motivator than financial gain because most employees want to feel they are part of something bigger than themselves. They want to learn, evolve, and create new and exciting things in their workplace.1-3,9,10

The desire to excel on the job comes from within when an employee is internally incentivized to reach for a goal.2 Although external motivational forces have their benefits and should not be discounted, they are subject to each employee’s individual, intrin- sic concerns, and the individual needs to “buy into” them for them to have a positive impact.2

Many employees rate motivating factors such as good working relationships with colleagues, training opportunities, and environmental factors (such as, good physical conditions) as more important than income.8 A review of 12 empirical studies of motiva- tion found that seven major job characteristics were important determinants of motivation. These are the work itself, healthy relationships with others, work- place conditions, opportunities for personal develop- ment, pay/rewards, management practices, and organizational policies.8 Two other important factors include being given choices and being involved in decision making.9 Managers need to identify each employee’s intrinsic motivators and align these needs with the needs of the department. Managers are key people who can help their employees behave in ways that positively meet their personal, internal needs as well as perform at higher levels and work more effectively with others.2 (See Extrinsic and intrinsic motivational factors.)

Demotivators Demotivators decrease employees’ desires to con- tribute positively to the organization. Managers must find demotivators within their departments and work to eliminate them. If a demotivator is an employee who thrives on complaining, for example, the manager should allow that employee 5 minutes to air a grievance and then ask that person to sug- gest a solution. This moves the conversation away from the drama and toward the harmony of mov- ing forward.

Managers also can cause demotivation when they micromanage, play favorites, pass their work off to their staff, display coercive types of control, and are manipulative.2,3,6 Demotivation can lead to frustration, hostility, laziness, defensiveness, self- doubt, judgment of others, inflexibility, misplaced

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Extrinsic and intrinsic motivational factors

Job content characteristics

External factors Internal factors

• Challenging nature of the work • Skill variety–degree to which a job utilizes a

mix of employee knowledge, skills, and abilities • Task identity–degree to which job involves completing a

complete project versus a piece of work • Task significance–degree to which job makes a recognizable

impact or contribution • Ability to provide quality care • Job enlargement–makes job structurally bigger; improves

job horizontally • Opportunity to advance • Career development opportunities that cultivate skills

(professional growth) • Authority level • Level of job control–influence in planning work and reviewing

results and setting standards for performance targets • Clearly defined nursing roles and responsibilities • Explicit in departmental or organizational goals • Constructive and objective system of performance appraisal

and merit rating

• Meaningful work (skill variety, task identity, and task significance)

• Job enrichment (challenging job) • A sense that one’s expectations can

be filled • Creativity opportunities • Decision making • Sense of control over work • Setting own goals • Job pride • Delegated authority • Sense of competence • Perceived increased work

effectiveness

Work environment

• Well-defined and humanistic personnel policy where the workforce is valued and their needs and aspirations can be satisfied

• Good working relationships • Teamwork • Adequate staffing • Culture that supports professional growth,

leadership development, and mentorship • Enthusiastic and warm work environment where

ideas and goals can be shared • Staff included on councils • Increased power and authority • Autonomy • Empowerment • Trusting • Positive reinforcement • Resources (tools, information, support)

to perform the job • Pleasant physical conditions of environment • Safe and respectful work environment • Distributive justice • Job security • Sound and fair promotion and transfer policies • Well-planned, need-based training, and development

programs

• Strong interpersonal work relationships

• Social acceptance • Positive interactions with

physicians • Minimal perceived environmental

turbulence • Set own work schedule and breaks • Feelings of accomplishment and

making a difference; taking pride in work performed

• Feel like valued member of team • Professionalism • Work-life balance with manageable

and suitable workloads • Hardiness (resilience) — able to deal

with turbulent work environment because see uncertainty in the environment as challenging, not threatening; ability to improvise and adapt to significant change

(Continued)

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Motivation: What makes you tick?

Extrinsic and intrinsic motivational factors (continued)

Leadership

• Two-way communication that is respectful and open • Be a good listener–appreciate what others have to say • Maintain visibility • Demonstrate trust and respect • Show others that you value their perspectives–

seek their opinions and ideas and implement them • Show confidence in employee’s ability to perform

at a high level • Encourage participation in decision making • Delegation of responsibility • Help staff set ambitious goals and help them work toward

these goals–extend people beyond their comfort zone • Coaching, role modeling, mentorship • Eliminate obstacles for employees to succeed • Accurate, honest, and constructive feedback on work effec-

tiveness; should be corrective but not punitive; also point out the positive and provide encouragement

• Honest praise; sincere compliments • Good performance rewarded adequately • Treat people consistently and fairly • Shows concern for employee as an individual • Provides rewards (bonuses, gift certificates, certificates of

appreciation, thank-you notes, day off with pay, parking spot closest to facility for a month, articles in local paper or internal newsletter)

• Sense of self-efficacy • Recognition of efforts when suc-

cessful, or when attempted to improve effectiveness or productiv- ity, or overcame an obstacle

• Earned respect • Input is sought for decision making • Feel empowered • Autonomy–independence and

freedom • Knowing what is expected to do

the job (preparedness) • Knowledge of results (feedback)

Benefits

• Fair wages and salary administration • Financial incentives • Paid time off • Medical and life insurance benefits • Retirement pension • Location of facility

• Feel appreciated and rewarded financially

Sources: http://www.egyankosh.ac.in/jspui/bitstream/123456789/38773/1/unit-15.pdf; Bruce A. Manager’s Guide to Motivating Employees. 2nd ed. Madison, WI: McGraw-Hill; 2011; Callicutt D, Norman K, Smith L, Nichols A, Kring D. Building an engaged and certified nursing workforce. Nurs Clin North Am. 2011;46(1):81-87; Gambino KM. Motivation for entry, occupational commitment and intent to remain: a survey regarding registered nurse retention. J Adv Nurs. 2010;66(11):2532-2541; Brady Germain P, Cummings GG. The influence of nursing leadership on nurse performance: a systematic literature review. J Nurs Manag. 2010;18(4):425-439; Hahn JJ, Butz KP, Gavin JG, Mills RS, Welter CJ. Recognizing professional and volunteer activities. AORN J. 2004;79(5):1006-1010; Lambrou P, Kontodimopoulos N, Niakas D. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. Hum Resour Health. 2010;8:26. http://www.human-resources-health.com/content/8/1/26; Llanos EB. Motivating co-workers. Advance for Nurses, Northeast. 2013;28-30; Mone E, Eisinger C, Guggenheim K, et al. Performance management at the wheel: driving employee engagement in organizations. J Bus Psychol. 2011;26:205-212; Newcomb P, Smith A, Webb P. Relationship of nurse job satisfaction to implementation of a nursing professional practice model. Southern Online Journal of Nursing Research. http://www.resourcenter.net/images/SNRS/Files/SOJNR_articles2/Vol09Num03Art11.pdf; Peters DH, Chakraborty S, Mahapatra P, Steinhardt L. Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states. Hum Resour Health. 2010;8(27):1-11; Shermont H, Krepcio D, Murphy JM. Career mapping: developing nurse leaders, reinvigorating careers. J Nurs Adm. 2009;39(10):432-437; Sledge S, Miles AK, van Sambeek MF. A comparison of employee job satisfaction in the service industry: do cultural and spirituality influences mat- ter? Journal of Management Policy and Practice. 2011;12(4):126-145; Utriainen K, Kyngäs H. Hospital nurses’ job satisfaction: a literature review. J Nurs Manag. 2009;17(8):1002-1010.

www.ORNurseJournal.com March OR Nurse 2015 43

priorities, absenteeism, poor staff retention, low productivity, and apathy.3 Managers can combat demotivation by holding regular staff meetings, soliciting feedback from employees, offering incen- tives, praising successful employees, celebrating vic- tories, and showing concern about employees beyond the workplace.

Multigenerational influences Multigenerational differences among employees need to be considered when discerning which extrinsic and intrinsic factors might be more likely to motivate certain people. Nurses raised in different generations may respond differently to extrinsic forces cultivated in the work area. Understanding these additional differences will help managers choose more appropriate actions to motivate employees. It is important to always take a closer look at where the individual “is coming from” based on their age-group, which can offer new ways to change attitudes and increase motiva- tional levels.7

The employee’s role Thoughts and behaviors, which are derived from internal urges, result in actions to fulfill current or future personal goals or desires. A sense of purpose results when an employee’s activities align with his or her values and beliefs. Employees should understand and attend to their internal forces in order to build on their motivation levels. The higher the need satis- fied by an activity in the workplace, the greater the motivation will be to perform that activity.2,11

Nurses have their own internal working styles that drive them to achieve and satisfy personal desires. These motivational forces can be positive, neutral, or negative, which directly impact the level of success nurses will have within the healthcare facility. Positive internal motivational forces result in “organizational citizenship” where the nurse is results-oriented, believes the organization and the nurse are part of an integrated unit, and views his or her assigned tasks as a fundamental duty. Nurses who feel neutral may function at a subsistence level where they perform their required duties but only at a minimal level. These nurses survive in the organization but do not have any concern for long- term results. Finally, nurses who harbor negative beliefs about themselves, their capabilities, the peo- ple around them, or how things are viewed in the

world will find their abilities to be successful to be stunted and limited.4,11

Nurses should participate in the creation of their workplace cultures by engaging in activities that enhance the work experience. Nurses are responsible to communicate professionally with their nurse lead- ers about what they need to complete their tasks effi- ciently and expertly.12 In other words, everyone has an inherent responsibility to make their work experi- ences better for themselves and for their patients.

The manager’s role Managers should seek to understand what motivates each of their employees and then help them make the connection between those inner drives and the needs of the department.2 Nurses with greater inter- nal needs for professional growth, for example, might demonstrate a more positive response to job enrichment than other nurses might.13 Nurses who view their work as a 9-to-5 job might be more enticed by financial rewards.

One of the characteristics of a leader is the ability to influence the actions of others toward accomplish- ing specific goals. Before a manager can do this, how- ever, he or she needs to be motivated. This internal desire within the manager ultimately will ignite the passion in the employees. A manager’s attitudes, behaviors, and practices directly influence those of the employees. If a leader is not motivated, how can the staff be?2,3,14 Only when a leader understands his or her own internal motivation can he or she more readily understand the employees’ motivational forc- es and the best way to guide and motivate them.11

Employee motivation is of great concern to leaders, as it directly impacts human behavior and attitudes toward work. Just as employees have certain desires the organization is expected to satisfy, the organization also expects certain types of behaviors from employees. The task for the leader is to make the work more interesting, pur- poseful, and acceptable to employees so they per- form it more enthusiastically and with a greater sense of responsibility. Leaders need to search for opportunities to create, develop, and improve pro- cesses and to enable others to act to feel compe- tent and dedicated.

Employees are motivated to do a job well when it helps them meet one or more of their personal needs, aims, objectives, and values. The challenge for managers is that different people have different

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Motivation: What makes you tick?

needs, and these needs change over time and according to the context of the situation.2,12 “There is no single magic wand to motivate employees, as their needs and priorities of satisfaction differ. What may motivate one may not motivate the other.”3 Managers can assist their nurses uncover their motivational forces to reach their highest level of per- formance and productivity. A first step is to ask the nurse what motivates him or her. If the answer lies buried, then the manager needs to get to know the nurse on a more personal level to learn these inner desires. This also can be accomplished by observing individual actions and behaviors and interpreting them in terms of some underlying motivation.3

Motivated managers see their role as facilitators, trainers, and coaches; they provide inspirational moti- vation through enthusiasm and challenge. These managers clearly articulate a vision, encourage the evolution of the individual and team spirit, and sup- port goal achievement. Effective leaders develop and maintain a trusting and positive motivational climate so that nurses feel satisfied and motivated to consis- tently perform at their highest level of productivity. This is accomplished by understanding nurses’ desires, appealing to their sense of self-improvement and self- worth as human beings, and working to elevate their level of effectiveness to accomplish departmental goals. It is up to the manager to assist their nursing staff to connect their intrinsic motives to the organiza- tion’s goals.2 Employees will surprise their managers with their levels of motivation to perform high-quality patient care when their assignments meet their inner drives (see Stimulating motivation in employees).2,6,12,14,15

Leadership styles Leadership styles directly impact the manner in which managers brings out the best in their employees. There are three types of leadership styles: transactional, passive avoidant, and transfor- mational. The transactional leadership style is based on a reciprocal exchange between the leader and employees. In this relationship, leaders specify the standards of performance with a strong focus on deviations from this standard, and employees are given something in return for their adherence and acceptance of authority (incentives, pay raises, sta- tus increases). The leader is an authority figure, and staff members are motivated by the reward for their adherence. In the passive avoidant leadership style, the leader avoids involvement in important

issues or making decisions. Staff generally experi- ence lack of empowerment and are not committed to established goals.15

A strong relationship has been demonstrated between the transformational leadership style and clinical nurse job satisfaction.15 Transformational leadership, which is an inclusive and participative management style, is a process where leaders raise the aspirations and motivations of staff members to higher levels by appealing to ideals and values. A transformational leader engages others by finding a common purpose and meaning to achieve a com- mon set of goals. When a leader models a higher level of ideas, values, and behaviors, staff members begin to do so as well.

Employees are motivated because the leader helps them meet their individual needs. Transformational leaders challenge employees to excel, establish accountability, and create a collective team spirit with shared ownership to attain goals. They ensure a trust- ing environment with an open door policy, display confidence, actively listen and address concerns, pro- vide a clear mission and set of values, seek creative approaches to problem solving, provide a supportive climate for professional growth, and act as mentors and teachers.2,7,15 In this environment, staff members feel empowered to share and openly discuss their concerns and to participate in decision making.

An important concept within transformational leadership is “empowerment,” which is a heightened state of motivation that is caused by optimistic effort-reward expectations.16 Empowered nurses expect their efforts to succeed and are therefore motivated to exert high levels of effort. They also have a sense of accountability for their work and the results they achieve. Motivated employees work hard when they feel empowered to make decisions about their work and when they feel supported and have the resources.2,16 Empowerment makes the employee feel trusted and valued, which then fos- ters a sense of confidence.2 Empowerment challeng- es managers to share their formal and informal power with their nursing staff.12

Transformational leaders delegate and give their employees more discretion and choices. This helps them expand their minds, develop their talents and skills, discover untapped abilities, and ultimately leads to feelings of a greater sense of self-efficacy, self- determination (control), and self-responsibility for improving the way they do their jobs and contribute

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to the organization’s goals. As a result, nurses have greater job satisfaction, are more motivated and com- mitted to their work, and involve more of them- selves. These attributes are associated with patient satisfaction, patient care, and patient safety.2,7,17

Nursing leadership behaviors directly influence nurses’ abilities to exceed their employer’s expecta- tions in meeting organizational goals.12 Leadership practices affecting motivation and work performance include: • encouraging the heart: providing encouragement and celebrating accomplishments

• inspiring a shared vision through commitment • enabling others to act • challenging the process • modeling the way • leadership with building, coaching, and mentoring.12

Employee engagement is an important outcome of working for a transformational leader. An engaged employee is not only fully involved in and enthusiastic about work but is also “inspired by it, committed to it, and fascinated by it.”9 Engaged employees align their own purpose with the organi- zation’s values and goals so that they are personally

Stimulating motivation in employees • Share the overall organizational strategy and

discuss with the staff. • Employees should understand how their work

supports organization strategy and direction. • Visibility, interaction, and communication with

the staff should be advocated. • Raising the bar regarding the expectations from

the staff. Employees will perform better if the manager expects high-level performance.

• Collaboratively set performance and develop- ment goals with the employee.

• Employees who have been successful in their work or accomplishing specific goals should be recognized.

• Stretch goals should be determined with the employee to enhance personal growth, profes- sional development, and to improve organiza- tional effectiveness.

• Employees should be allowed to tackle sur- mountable assignments before engaging in more difficult tasks.

• Employees should be treated as partners to increase buy-in and to achieve better performance.

• Cross-training–employees appreciate each other more when they have walked in each other’s shoes.

• Opportunities for training and development (such as in-house education) should be provided

along with career development and advance- ment efforts.

• Guidance and coaching should be provided. • Staff should be mentored for long-term profes-

sional development. • Performance appraisals are to be objective,

measurable, and transparent. • Tie raises to performance, not seniority. • A climate of trust, ownership, empowerment,

and autonomy should be fostered. • Creativity and innovation should be

encouraged. • Employees should be included in the decision-

making process. • Improvement in work processes and productiv-

ity should also be encouraged. • Fairness and respectfulness of the staff should

be paramount. • The resources and authority needed for the staff

to perform effectively should be provided. • The staff should be advocated for. • An interest in the staff should be displayed. • Reinforcement, recognition, and rewards should

be provided. • An atmosphere where working relationships and

interactions are valued and emphasized should be promoted.

• Employees should share responsibility for improving work processes.

Sources: Bruce A. Manager’s Guide to Motivating Employees. 2nd ed. Madison, WI: McGraw-Hill; 2011;

Harvey P, Martinko MJ. Chapter 7: Attribution theory and motivation. In. N. Borkokwski (ed) Organizational Behavior, theory and Design in Health Care. Sudbury, MA:Jones and Bartlett Publishers, LLC. pp. 147-164. http://samples.jbpub.com/9780763763831/63831_08_CH07_final.pdf;

Kuokkanen L, Suominen T, Härkönen E, Kukkurainen ML, Doran D. Effects of organizational change on work-related empowerment, employee satis- faction, and motivation. Nurs Adm Q. 2009;33(2):116-124;

Mone E, Eisinger C, Guggenheim K, et al. Performance management at the wheel: driving employee engagement in organizations. J Bus Psychol. 2011;26:205-212;

Sikroria R, Srivastava V. Shaping employee oriented human resource policies through analyzing motivational needs. European Journal of Business and Management. 2012;4(14):177-181;

Utriainen K, Kyngäs H. Hospital nurses’ job satisfaction: A literature review. J Nurs Manag. 2009;17(8):1002-1010.

46 OR Nurse2015 March www.ORNurseJournal.com

Motivation: What makes you tick?

invested in their tasks and out- comes.2 Engagement is dis- played with personal initiative, being adaptable, effort, and persistence toward achieving the organizational goals.18 High levels of trust and fairness in the organizational culture are necessary to create and sustain an engaged workforce. Interventions for driving engagement include: • building confidence, resiliency, and social support networks • renewing or restoring employ- ee energy • empowerment • providing control over work • enhancing the motivation and freedom to engage • involving staff in decision making • providing effective recognition and rewards and fair and equitable treatment.18

Building engagement is based on “knowing, growing, inspiring, involving, and rewarding employ- ees,” which can produce organizational commit- ment and increased employee satisfaction levels.15,18

Engagement is a prerequisite before an employee can increase motivation levels.18

Organizations with engaged employees have employees who are 20% more likely to perform better and 87% less likely to leave the organization.9

The 10 Cs of employee engagement require leaders to do as follows: • connect with employees • provide opportunities for career advancement • provide a clear vision • convey meaningful feedback • congratulate strong performance • allow for employee contributions and control over their work • encourage collaboration among team members • establish credible standards • create confidence.9

Managers need to create a trusting environment where nurses can flourish, get swift feedback and recognition, and earn rewards for their good ideas.2

They also need to build confidence, cultivate feelings of ownership, and allow their nurses to question, challenge, influence, and make decisions. Motivated

nurses take exceptional pride in their work. When they experi- ence this, they work at a consis- tently higher capacity and are more motivated and satisfied at their job. Employees work hard- er and smarter, not for their manager or the organization, but for themselves. Managers, however, are the link between nurses meeting their own needs and doing exceptional work for the healthcare facility. Nurses need to understand how their own and the healthcare facility’s values connect to bring meaning to their life through work. Those managers who work to build hope and trust will find a moti- vated workforce.2,11

Job satisfaction Employee motivation and job satisfaction are related but distinct phenomena. Job satisfaction is an individ- ual’s emotional response to his or her job condition; motivation is the driving force to pursue and satisfy needs.5 Employees are more likely to feel satisfied when they perceive that their efforts are rewarded based on their standards and internal motivators.19

Motivational levels and job satisfaction are positively correlated and both work together to increase job performance.5,10,13,19 The following themes are relat- ed to nurses’ job satisfaction: • positive interpersonal relationships and communica- tion between nurses and other healthcare providers • nurses who believe they provide high-quality care and have a strong connection to patients • a culture where management and employees con- sult together on decision making • teamwork and peer support • control over nursing practice • empowerment and autonomy • participation and open discussion • sensitivity for employees’ ideas • loyalty and trust.10,19

Meeting the needs and achieving the goals of both the nurse and the healthcare facility provide the “cornerstone” for job satisfaction.5 “Job satisfaction is inextricably linked to motivation, and both involve cognitive, affective, and behavioral processes, with

Nurses should participate in the creation of their

workplace cultures by engaging in activities that enhance the work

experience.

www.ORNurseJournal.com March OR Nurse 2015 47

employee motivation commonly understood as the reason why employees behave as they do towards achieving personal and organizational goals.”8 OR

REFERENCES

1. Hahn JJ, Butz KP, Gavin JG, Mills RS, Welter CJ. Recognizing profes- sional and volunteer activities. AORN J. 2004;79(5):1006-1010.

2. Bruce A. Manager’s Guide to Motivating Employees. 2nd ed. Madison, WI: McGraw-Hill; 2011.

3. http://www.egyankosh.ac.in/jspui/bitstream/123456789/38773/1/ unit-15.pdf.

4. Sikroria R, Srivastava V. Shaping employee oriented human resource policies through analyzing motivational needs. European Journal of Busi- ness and Management. 2012;4(14):177-181.

5. Lambrou P, Kontodimopoulos N, Niakas D. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. Hum Resour Health. 2010;8:26. http://www.human-resources- health.com/content/8/1/26.

6. Wysocki AF, Kepner KW, Glasser MW. Associates and motivation, Uni- versity of Florida. http://www.edis.ifas.ufl.edu/pdffiles/HR/HR00400.pdf.

7. Llanos EB. Motivating co-workers. Advance for Nurses, Northeast. 2013;15(7):25-27.

8. Peters DH, Chakraborty S, Mahapatra P, Steinhardt L. Job satisfac- tion and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states. Hum Resour Health. 2010;8(27):1-11.

9. Callicutt D, Norman K, Smith L, Nichols A, Kring D. Building an en- gaged and certified nursing workforce. Nurs Clin North Am. 2011;46(1): 81-87.

10. Utriainen K, Kyngäs H. Hospital nurses’ job satisfaction: a literature review. J Nurs Manag. 2009;17(8):1002-1010.

11. Coombes F. Motivate Yourself and Reach Your Goals. Blacklick, OH: McGraw-Hill; 2010.

12. Brady Germain P, Cummings GG. The influence of nursing lead- ership on nurse performance: a systematic literature review. J Nurs Manag. 2010;18(4):425-439.

13. Sledge S, Miles AK, van Sambeek MF. A comparison of employee job satisfaction in the service industry: do cultural and spirituality influences matter? Journal of Management Policy and Practice. 2011;12(4):126-145.

14. Feltner A, Mitchell B, Norris E, Wolfle C. Nurses’ views on the characteristics of an effective leader. AORN J. 2008;87(2):363-372.

15. Schwartz DB, Spencer T, Wilson B, Wood K. Transformational leadership: implications for nursing leaders in facilities seeking Magnet designation. AORN J. 2011;93(6):737-748.

16. Harvey P, Martinko M. Attribution theory and motivation. http:// samples.jbpub.com/9780763763831/63831_08_CH07_final.pdf.

17. Kuokkanen L, Suominen T, Härkönen E, Kukkurainen ML, Doran D. Effects of organizational change on work-related empowerment, em- ployee satisfaction, and motivation. Nurs Adm Q. 2009;33(2):116-124.

18. Mone E, Eisinger C, Guggenheim K, et al. Performance manage- ment at the wheel: driving employee engagement in organizations. J Bus Psychol. 2011;26(2):205-212.

19. Newcomb P, Smith A, Webb P. Relationship of nurse job satis- faction to implementation of a nursing professional practice model. Southern Online Journal of Nursing Research. http://www.resourcenter.net/ images/SNRS/Files/SOJNR_articles2/Vol09Num03Art11.pdf.

Debra Dunn is the Perioperative Nurse Director at East Orange General Hospital, East Orange, N.J.

The author has disclosed that she has no financial relationships related to this article.

DOI-10.1097/01.ORN.0000460902.65598.e0

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