18

443

UNIT 6 Roles and Functions in Directing

C H A P T E R

18

Creating a MotivatingClimate

How we feel about and enjoy our work is crucial

to how we perceive the quality of our lives.

—Jo Manion

This unit reviews the fourth phase of the management process: directing. This phasealso may be referred to as coordinating or activating. Regardless of the nomenclature,this is the “doing’’ phase of management, requiring the leadership and managementskills necessary to accomplish the goals of the organization. Managers direct the workof their subordinates during this phase. Components of the directing phase discussedin this textbook include creating a motivating climate, establishing organizationalcommunication, managing conflict, facilitating collaboration, negotiating, and theimpact of collective bargaining and employment laws on management.

In planning and organizing, managers attempt to establish an environment thatis conducive to getting work done. In directing, the manager sets those plans intoaction. This chapter focuses on creating a motivating climate as a critical element inmeeting employee and organizational goals.

The amount and quality of work accomplished by managers directly reflect theirmotivation and that of their subordinates. Why are some managers or employees moremotivated than others? How do demotivated managers affect their subordinates?What can the manager do to help the employee who is demotivated? The motiva-tional problems frequently encountered by the manager are complex. To respond todemotivated staff, managers need an understanding of the relationship betweenmotivation and behavior.

Motivation may be defined as the force within the individual that influences ordirects behavior. Because motivation comes from within the person, managers cannotdirectly motivate subordinates. The humanistic manager can, however, create anenvironment that maximizes the development of human potential. Managementsupport, collegial influence, and the interaction of personalities in the work groupcan have a synergistic effect on motivation. The leader–manager must identifythose components and strengthen them in maximizing motivation at the unit level.

All human beings have needs that motivate them. The leader focuses on theneeds and wants of individual workers and uses motivational strategies appropriatefor each person and situation.

Lee (2000) states that, “motivation, mentoring, and empowerment aren’t justmanagement jargon: they should be resources you use every day’’ (p. 25). Leadersshould apply techniques, skills, and knowledge of motivational theory to helpnurses achieve what they want out of work. At the same time, these individualgoals should complement the goals of the organization. The manager bears pri-mary responsibility for meeting organizational goals, such as reaching acceptablelevels of productivity and quality.

The leader–manager, then, must create a work environment in which bothorganizational and individual needs can be met. Adequate tension must be createdto maintain productivity while encouraging subordinates’ job satisfaction. Thus,while the worker is achieving personal goals, organizational goals are being met.The leadership roles and management functions inherent in creating such anenvironment are included in Display 18.1.

This chapter examines motivational theories that have guided organizationalefforts and resource distribution for the last 80 years. Special attention is given tothe concepts of intrinsic versus extrinsic motivation and organizational motivationversus self-motivation.

444 UNIT 6 � Roles and Functions in Directing

The leader also is therole model, listener,supporter, andencourager fordemotivated employees.

INTRINSIC VERSUS EXTRINSIC MOTIVATION

Motivation is the action people take to satisfy unmet needs. It is the willingnessto put effort into achieving a goal or reward to decrease the tension caused by theneed. Intrinsic motivation comes from within the person, driving him or her to beproductive. To be intrinsically motivated at work, the worker must value job per-formance and productivity.

445CHAPTER 18 � Creating a Motivating Climate

Leadership Roles1. Recognizes each worker as a unique individual who is motivated by different things.2. Identifies the individual and collective value system of the unit, and implements a

reward system that is consistent with those values.3. Listens attentively to individual and collective work values and attitudes to identify

unmet needs that can cause dissatisfaction.4. Encourages workers to “stretch’’ themselves in an effort to promote self-growth and

self-actualization.5. Maintains a positive and enthusiastic image as a role model to subordinates in the

clinical setting.6. Encourages mentoring, sponsorship, and coaching with subordinates.7. Devotes time and energy to create an environment that is supportive and

encouraging to the discouraged individual.8. Develops a unit philosophy that recognizes the unique worth of each employee and

promotes reward systems that make each employee feel like a winner.9. Demonstrates through actions and words a belief in subordinates that they desire to

meet organizational goals.10. Is self-aware regarding own enthusiasm for work and takes steps to remotivate self

as necessary.

Management Functions1. Uses legitimate authority to provide formal reward systems.2. Uses positive feedback to reward the individual employee.3. Develops unit goals that integrate organizational and subordinate needs.4. Maintains a unit environment that eliminates or reduces job dissatisfiers.5. Promotes a unit environment that focuses on employee motivators.6. Creates the tension necessary to maintain productivity while encouraging subordinate

job satisfaction.7. Clearly communicates expectations to subordinates.8. Demonstrates and communicates sincere respect, concern, trust, and a sense of

belonging to subordinates.9. Assigns work duties commensurate with employee abilities and past performance to

foster a sense of accomplishment in subordinates.10. Identifies achievement, affiliation, or power needs of subordinates, and develops

appropriate motivational strategies to meet those needs.

Leadership Roles and Management FunctionsAssociated with Creating a Motivating WorkClimate

Display 18.1

The intrinsic motivation to achieve is directly related to a person’s level of aspira-tion. Parents and peers play major roles in shaping a person’s values about what heor she wants to do and be. Parents who set high but attainable expectations for theirchildren, and who constantly encourage them in a nonauthoritative environment,tend to impart strong achievement drives in their children. Cultural backgroundalso has an impact on intrinsic motivation; some cultures value career mobility, jobsuccess, and recognition more than others.

Extrinsic motivation is motivation enhanced by the job environment or externalrewards. The reward occurs after the work has been completed. Although all peopleare intrinsically motivated to some degree, it is unrealistic for the organizationto assume that all workers have adequate levels of intrinsic motivation to meetorganizational goals. Thus, the organization must provide a climate that stimulatesboth extrinsic and intrinsic drives.


The intrinsic motivationto achieve is directlyrelated to a person’slevel of aspiration.Extrinsic motivation ismotivation enhanced bythe job environment orexternal rewards.

Thinking about MotivationThink back to when you were a child. What rewards did your parents useto promote good behavior? Was your behavior more intrinsically orextrinsically motivated? Were strong achievement drives encouraged andsupported by your family? If you have children, what rewards do you use?Are they the same rewards your parents used? Why or why not?

Learning Exercise 18.1

Because people have constant needs and wants, people are always motivated tosome extent. In addition, because all human beings are unique and have differentneeds, they are motivated differently. The difference in motivation can be explainedin part by our large- and small-group cultures. For example, because American culturevalues material goods and possessions more highly than many other cultures, rewardsin this country are frequently tied to these values.

Organizations also have cultures and values. Motivators vary between organizationsand even between units in organizations. Even in similar or nearly identical work envi-ronments, large variations in individual and group motivation often exist. Muchresearch has been undertaken by behavioral, psychological, and social scientists todevelop theories and concepts of motivation. Economists and engineers have focusedon extrinsic fiscal rewards to improve performance and productivity, whereas humanrelations scientists have stressed intrinsic needs for recognition, self-esteem, andself-actualization. To better understand the current view that both extrinsic andintrinsic rewards are necessary for high productivity and worker satisfaction, oneneeds to look at how motivational theory has evolved over time.

MOTIVATIONAL THEORY

Chapter 2 introduced traditional management philosophy that emphasizes paternal-ism, worker subordination, and bureaucracy as a means to predictable but moderate

Because motivation is so complex, the leaderfaces tremendouschallenges in accuratelyidentifying individualand collectivemotivators.

productivity. In this philosophy, high productivity means greater monetary incentivesfor the worker, and workers are viewed as being motivated primarily by economic fac-tors. This traditional management philosophy is still in use today. Many factory andassembly line production jobs and jobs that use production incentive pay are based onthese principles.

The shift from traditional management philosophy to a greater focus on thehuman element and worker satisfaction as factors in productivity began during thehuman relations era (1930–1970). The best-known human motivation studies inthis era were the Hawthorne studies conducted by Elton Mayo (1953).

Maslow

Continued focus on human motivation did not occur until Abraham Maslow’swork in the 1950s. Most nurses are familiar with Maslow’s hierarchy of needs andtheory of human motivation. Maslow (1970) believed that people are motivated tosatisfy certain needs, ranging from basic survival to complex psychological needs,and that people seek a higher need only when the lower needs have been predomi-nantly met. Maslow’s hierarchy of needs is depicted in Figure 18.1.

Although Maslow’s work helps explain personal motivation, his early work,unfortunately, was not applied to motivation in the workplace. His later work, how-ever, offers much insight into motivation and worker dissatisfaction. Because ofMaslow’s work, managers began to realize that people are complex beings, not solelyeconomic animals, and that they have many needs motivating them at any one time.It also became clear that motivation is internalized and that if productivity is toincrease, management must help employees meet lower-level needs. This shiftingfocus on what motivates employees has tremendously affected how organizationsvalue workers today.


Figure 18.1 Maslow’s hierarchy of needs.

-f---fff--fffflf-ffffllelf-fffflleelfffflleeeelfflleeeeeelleeeeeeeSeeeeeeSSSeeeeSSSSSeeSSSSSSSeSSSSSSSSSSSSSSSSSSSSSSSSSSSS f-f-lf-lf-elf-elfelSelSeSeSeSSSSSnnnnnnnnnonnnnnnnnoonnnnnnnnoooonnnnnooooooionnnoooooooitionooooooiittiooooiittttatiooiittttataatioiittttataaaatiittttataaaaazatttataaaaaaz nnonononiontioatioatioatiatzaaaaaazzzzzaaazzzzzzzazzzzzzziizazzzzziilizzzziillalizziillaaaliziillaaaaaliillaaaaaalllaaaaaaauaaaaaauuaaaauuuuaauuuuuuauuuuuutuuuuuutttuuuuttttctuuttttcctuttttccccttttccccccttccccccacccccaaaccccaaaaccaaaaaacaaaaaaaaaaaaaaaaaa zatzazaizalizalizalizalialaluauauatuatuctuctuctuctactacacacacaaa

sssssssssssssssssssssssssssssssssdddddddddddddddddddddddddddddddddddddddddeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeneeeeeeeennnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnc cccccc cccccccccccccccccccccccccccccicccccciciiiiiccsissiiiiiisssssssiiissssssssssssssssssassssaaaaasaaaaaaaaaaaaaaaBBBBBBBBBBBBBBBBBBBaBaaaaaasasssssisiicicccc c c nnnnneeeeeeeeedddBasic needBasic needsBasic needsBasic needsBasic needsBasic needs/Bas/Bas/Bas/Basi/Basicl/Basicl/Basic al/Basic al/Basic al/Basic al/Basic cal/Basic cal/Basic ical/Basic gical/Basic PhysioPPPPhhhyyyyPhysioPPPP yyyyyyyyyPhysioPPPPhhhhyyyysiologsiologsiologsiologsiologggggggPhysiolPPPPPhhhhyyyysiologsiologsiologssiioooo ggggggoooooooooPhysiolPPPPPhhhhyyyyyssssioooolooogggggggooooooPhysioloPPPPPhhhhyyyyyssssioooolooooogggggooooooPhysioloPPPPPhhhhyyyyyssssioooooloooooggPhysioloPPPPPhhhhyyyyyssssioooooloooogPhysioloPPPPhhhhyyssssioooooloooohysiolohhh ssioooollooooysioloiooooloooosioloii looooioloi lollll gical/Basic ogical/Basicogical/Basiclogical/Basicological/Basiciological/Basisiological/Basysiological/Bashysiological/BasPhysiological/BaPhysiological/BaPhysiological/BPhysiological/BPhysiological/PhysiologicaPhysiologicPhysiologPhysioloPhysioy

mmmmmmmmmmmmmmmmmmmmmmmemmmmmmmmmmmeemmmmmmmmmmmeeeeemmmmmmmmmmeeeeeeemmmmmmmeeeeeeeeeemmmmmeeeeeeeeeeeemmeeeeeeeeeeeeeemeeeeeeeeeeeeeteeeeeeeeeeeeettteeeeeeeeeettttsteeeeeeeettttsssteeeeettttssssteeettttsssssstettttssssssEstettttssssssEEEsttttssssssEEEEEsttsssssEEEEEEssssEEEEEEEEssEEEEEEEEEsEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEEE mmmmemememeemeemeemteemteesteesteestesteEsteEsteEstEstEsEsEsEEEEE

Security/SafetyyyyyyyySecurity/SafetySecurity/SafetySecurity/SafetySecurity/SafetySecurity/SafetySecurity/SafetySecu y/Sa e y

Social/Love

Skinner

B. F. Skinner was another theorist in this era who contributed to the understand-ing of motivation, dissatisfaction, and productivity. Skinner’s (1953) research onoperant conditioning and behavior modification demonstrated that people could beconditioned to behave in a certain way based on a consistent reward or punish-ment system. Behavior that is rewarded will be repeated, and behavior that ispunished or goes unrewarded is extinguished. Skinner’s work continues to bereflected today in the way many managers view and use discipline and rewards inthe work setting.

Herzberg

Frederick Herzberg (1977) believed that employees can be motivated by the workitself and that there is an internal or personal need to meet organizational goals. Hebelieved that separating personal motivators from job dissatisfiers was possible.This distinction between hygiene or maintenance factors and motivator factors wascalled the Motivation–Hygiene theory or Two Factor theory. Display 18.2 listsmotivator and hygiene factors identified by Herzberg.

Herzberg maintained that motivators or job satisfiers are present in work itself;they give people the desire to work and to do that work well. Hygiene or mainte-nance factors keep employees from being dissatisfied or demotivated but do not actas real motivators. It is important to remember that the opposite of dissatisfactionmay not be satisfaction. When hygiene factors are met, there is a lack of dissatisfac-tion, not an existence of satisfaction. Likewise, the absence of motivators does notnecessarily cause dissatisfaction.

For example, salary is a hygiene factor. Although it does not motivate in itself,when used in conjunction with other motivators, such as recognition or advance-ment, it can be a powerful motivator. If, however, salary is deficient, employeedissatisfaction can result. Some argue that money can truly be a motivator, as evi-denced by people who work insufferable hours at jobs they truly do not enjoy.Some theorists would argue that money in this case might be taking the place ofsome other unconscious need.


Motivators Hygiene FactorsAchievement SalaryRecognition SupervisionWork Job securityResponsibility Positive working conditionsAdvancement Personal lifePossibility for growth Interpersonal relationships and peers

Company policyStatus

Herzberg’s Motivators and Hygiene FactorsDisplay 18.2

Some people in Herzberg’s studies, however, did report job satisfaction solelyfrom hygiene or maintenance factors. Herzberg asserts that these people are onlytemporarily satisfied when hygiene factors are improved, show little interest in thekind and quality of their work, experience little satisfaction from accomplishments,and tend to show chronic dissatisfaction with other hygiene factors, such as salary,status, and job security.

Herzberg’s work suggests that although the organization must build on hygieneor maintenance factors, the motivating climate must actively include the employee.The worker must be given greater responsibilities, challenges, and recognition forwork well done. The reward system must meet both motivation and hygiene needs,and the emphasis given by the manager should vary with the situation and employeeinvolved. Although hygiene factors in themselves do not motivate, they are neededto create an environment that encourages the worker to move on to higher-level needs.Hygiene factors also combat employee dissatisfaction and are useful in recruiting anadequate personnel pool. Vaughn’s (2003) study showed that among the numerousretention factors suggested by Herzberg’s Two Factor theory, nurses most desired asense of recognition and achievement.

Vroom

Victor Vroom (1964), another motivational theorist in the human relations era,developed an expectancy model, which looks at motivation in terms of the person’svalence, or preferences based on social values. In contrast to operant conditioning,which focuses on observable behaviors, the expectancy model says that a person’sexpectations about his or her environment or a certain event will influence behavior.In other words, people look at all actions as having a cause and effect; the effect maybe immediate or delayed, but a reward inherent in the behavior exists to motivaterisk taking. In Vroom’s expectancy model (Figure 18.2), people make conscious


Expectancy

EffortPerformance Reward

Valence

Figure 18.2 Vroom’s expectancy model.

decisions in anticipation of reward; in operant conditioning, people react in astimulus–response mode. Managers using the expectancy model must becomepersonally involved with their employees to understand better the employees’ values,reward systems, strengths, and willingness to take risks.

McClelland

David McClelland (1971) has examined what motives guide a person to action.McClelland states that people are motivated by three basic needs: achievement,affiliation, and power. Achievement-oriented people actively focus on improvingwhat is; they transform ideas into action, judiciously and wisely, taking risks whennecessary. In contrast, affiliation-oriented people focus their energies on familiesand friends; their overt productivity is less because they view their contribution tosociety in a different light than those who are achievement oriented. Research hasshown that women generally have greater affiliation needs than men and that nurs-es generally have high affiliation needs. Power-oriented people are motivated by thepower that can be gained as a result of a specific action. They want to commandattention, get recognition, and control others. McClelland theorizes that managerscan identify achievement, affiliation, or power needs of their employees and developappropriate motivational strategies to meet those needs. Learning Exercise 18.2 isa self-evaluation tool that can be used to assess individual achievement, affiliation,and power needs.


Identifying Goals and MotivationList six goals you hope to accomplish in the next five years. Identify whichgoals are most related to achievement needs, affiliation needs, and powerneeds. Remember that most people are motivated in part by all threeneeds, and no one motivational need is better than the others. However,each person must recognize and understand which basic needs motivatehim or her most.


Gellerman

Saul Gellerman (1968), another humanistic motivational theorist, has identified sev-eral methods to motivate people positively. One such method, stretching, involvesassigning tasks that are more difficult than what the person is used to doing.Stretching should not, however, be a routine or daily activity. Kerfoot (2001) stated,“Just as an Olympic coach teaches, trains, inspires, and creates a culture and disci-pline to achieve extraordinary outcomes, the successful leader also helps peopleachieve outcomes they didn’t think were possible’’ (p. 125). Kerfoot goes on to saythat “raising the bar’’ is a consistent part of excellence in leadership.

The challenge is toenergize people to enjoythe beauty of pushingthemselves beyond what they thought theycould do.

Another method, participation, entails actively drawing employees into decisionsaffecting their work. Gellerman strongly believed that motivation problems usuallystem from the way the organization manages and not from the staff ’s unwillingnessto work hard. According to Gellerman, most managers “overmanage’’—they makethe employee’s job too narrow and fail to give the employee any decision-makingpower. Indeed, Friedrich (2001) asserts that decision-making input, autonomy, andindependence are critical elements to nurses for staying motivated in the workenvironment.

McGregor

Douglas McGregor (1960) examined the importance of a manager’s assumptionsabout workers on the intrinsic motivation of the workers. These assumptions,which McGregor labeled Theory X and Theory Y (depicted in Display 18.3), led tothe realization in management science that how the manager views, and thus treats,the worker will have an impact on how well the organization functions.

McGregor did not consider Theory X and Theory Y as opposite points on thespectrum, but rather as two points on a continuum extending through all perspectivesof people. McGregor believed that people should not be artificially classified as alwayshaving Theory X or Theory Y assumptions about others; instead, most people fall onsome point on the continuum. Likewise, McGregor did not promote either Theory Xor Theory Y as being the one superior management style, although many managershave interpreted Theory Y as being the ultimate management model. No one style iseffective in all situations, at all times, and with all people. McGregor, without makingvalue judgments, simply stated that in any situation, the manager’s assumptions aboutpeople, whether grounded in fact or not, affect motivation and productivity.

The work of all these theorists has added greatly to the understanding of whatmotivates people in and out of the work setting. Research has revealed that motiva-tion is extremely complex and that there is tremendous variation in what motivatesdifferent people. Therefore, managers must understand what can be done at the unitlevel to create a climate that allows the worker to grow, increases motivation andproductivity, and eliminates dissatisfiers that drain energy and cause frustration.


Theory X Employees Theory Y EmployeesAvoid work if possible Like and enjoy workDislike work Are self-directedMust be directed Seek responsibilityHave little ambition Are imaginative and creativeAvoid responsibility Have underutilized intellectual capacityNeed threats to be motivated Need only general supervisionNeed close supervision Are encouraged to participate in Are motivated by rewards and punishment problem solving

McGregor’s Theory X and Theory YDisplay 18.3


Crossword Puzzle: A Review of Motivational TheoryACROSS1. Maslow’s ___________ of needs.3. One of the three basic motivators identified by McClelland.5. Theorist who stated that one’s assumptions about human nature

influence his or her managerial behavior.7. Factor that keeps the worker from being dissatisfied but is not a true

motivator.8. Developed the expectancy theory.9. Described operant conditioning.DOWN2. Theorist who encouraged managers to “stretch’’ employees.4. Manager who believes workers are inherently lazy, need total direction,

and are externally motivated.6. These studies were completed by Elton Mayo and suggested that

individuals respond to the fact that they are being studied.

Note: Puzzle solution may be found in the appendix.


1

2 4

6

3

5

8

9

7

CREATING A MOTIVATING CLIMATE

Because the organization has such an impact on extrinsic motivation, it is impor-tant to examine organizational climates or attitudes that directly influence workermorale and motivation. For example, organizations frequently overtly or covertlyreinforce the image that each employee is expendable and that individual recogni-tion is in some way detrimental to the employee and his or her productivity withinthe organization. Just the opposite is true. “Employees are an organization’s mostvaluable asset’’ (Andrica, 2000, p. 307), and people who have a strong self-conceptand perceive themselves as winners are willing to take risks and increase their pro-ductivity to achieve greater recognition. Friedrich (2001) states that nurses who feelthat their contributions are noticed experience satisfaction, and nurses who experi-ence satisfaction stay where they are, contributing to an organization’s retention.

Some organizations, on the other hand, erroneously believe that if a smallreward results in desired behavior, then a larger reward will result in even more ofthe desired behavior. Thus, an employee’s motivation should increase proportion-ately with the amount of the incentive or reward. This simply is not true. Thereappears to be a perceived threshold beyond which increasing the incentive results inno additional meaning or weight. Organizations must be cognizant of the needto offer incentives at a level where employees value them. This requires that theorganization and its managers understand employees’ collective values and devise areward system that is consistent with that value system.

Managers also must be cognizant of an employee’s individual values and attemptto reward each worker accordingly. Levin (2001) stated, “Each employee’s commit-ment to the organization reflects the degree to which it can fulfill his/her tangible andintangible needs’’(p. 18).Therefore, the manager must assess individual employee val-ues and needs as well as organization values and then use his or her authority to bringthese values together. The ability to recognize each worker as a unique person who ismotivated differently and then to act upon those differences is a leadership skill.

In a study by Prothero, Marshall, Fosbinder, and Hendrix (2000) of RNs work-ing in two hospitals in the United States, the values of sense of accomplishment,equality, and being imaginative, helpful, self-controlled, and obedient were sig-nificantly associated with total work satisfaction. A sense of accomplishment,equality, comfortable life, pleasure and being imaginative, helpful, self-controlled,and courageous were associated with satisfaction with the task requirements ofthe job. The study concluded that managerial consideration of nurses’ personal valuesmight be a critical factor in increasing employee work satisfaction.

In addition to the climate created by the organization’s beliefs and attitudes, theunit supervisor or unit manager also has a tremendous impact on motivation at theunit level. Friedrich (2001) states that “the manner in which a first-line manager com-municates with employees affects staff attitude toward the organization, for he or sheusually has more influence over employees than any other level of manager’’ (p. 28).

Clearly, then, the interpersonal relationship between an employee and his or hersupervisor is critical to the employee’s motivation level. Kerfoot (2001) states, “Asleaders, it is often easy to get lost in the goals of our units and organizations. We oftenforget that the only way to achieve our goals is through the people who work with us’’(p. 125). Therefore, although managers cannot directly motivate employees, they can


create a climate that demonstrates positive regard for their employees, encourages opencommunication, recognizes achievement, and encourages growth and productivity.


The Strongest MotivatorIdentify the greatest motivator in your life at this time. Has it always beenthe strongest motivator? Could you list the strongest motivator for thesignificant others in your life? If so, have you ever used this awareness tomotivate those people to do something specific?


One of the most powerful, yet frequently overlooked or underused, motivatorsthe manager can use to create a motivating climate is positive reinforcement. Petersand Waterman (1982) have identified the following simple approaches for an effec-tive reward–feedback system that uses positive reinforcement:

• Positive reinforcement must be specific or relevant to a particular perform-ance. The manager should praise an employee for a specific task accom-plished or goal met. This praise should not be general. For example, saying,“Your nursing care is good’’ has less meaning and reward than, “The commu-nication skills you showed today as an advocate for Mr. Jones were excellent.I think you made a significant difference in his care.’’

• Positive reinforcement must occur as close to the event as possible.• Reward–feedback system must be achievable. All performance goals must be

attainable, and both large and small achievements should be recognized orrewarded in some way.

• Rewards should be unpredictable and intermittent. If rewards are givenroutinely, they tend to lose their value.

Making rewards unpredictable and intermittent is an approach that is open to sev-eral interpretations. If Peters and Waterman are advocating inconsistency when grant-ing rewards, the authors disagree because there must be consistency in how and whenrewards are given. When rewards lack consistency, there is greater risk that the rewarditself will become a source of competition and thereby lower morale. An attitude pre-vails that “there are a limited number of awards, and an award received by anyone elselimits the chances of my getting one; thus, I cannot support recognition for my peers.’’Likewise, rewarding one person’s behavior and not another’s who has accomplished asimilar task at a similar level promotes jealousy and can demotivate.

If, however, Peters and Waterman mean that rewards and praise should be spon-taneous and not relegated to predictable events, such as routine annual perform-ance reviews or recognition dinners, then the authors agree. Rewards and praiseshould be given whenever possible and whenever they are deserved.

If positive reinforcement and rewards are to be used as motivational strategies,then rewards must represent a genuine accomplishment on the part of the personand should be somewhat individual in nature. For example, many managers erro-neously consider annual merit pay increases as rewards that motivate employees.

Most employees, however, recognize annual merit pay increases as a universal“given’’; thus, this reward has little meaning and little power to motivate. Managersshould promote excellence within achievable goals and reward performance in away that is valued by their staff. These are the cardinal elements for a successfulmotivation–reward system for the organization.

It is important to remember that all nurse–managers can enhance the work oftheir subordinates by providing them with more opportunities to experience thechallenges that make their jobs exciting. Through shared governance, empower-ment, and participative management, managers can have a direct impact on moti-vation at the unit level.

Finding Joy at Work: A Shared Responsibility

For many in today’s healthcare organizations, some of the joy has gone from work,but it is possible to rekindle joy and to find both staff nurses and leaders who findtrue joy in their work. Manion (2003) says that positive mood is directly linked tomany different performance-related behaviors, including enhanced creativity, greaterhelping behavior, integrative thinking, inductive reasoning, more efficient decisionmaking, greater cooperation, and the use of more successful negotiation strategies.Manion elaborates by saying joyful people positively effect relationships and makethe workplace more appealing.

How is joy found in work? In Manion’s (2003) study, most of the participants feltthat joy was an individual thing. However, her findings strongly suggested that theorganization played a role in setting a climate for joy in work to occur; the creationof a positive work environment, hiring and retaining good people, adequate benefitsand compensation, providing adequate resources, and living up to its mission wereidentified as contributing factors.

Pathways to Joy

Manion (2003) found that there were several personal pathways (see Display 18.4)that individual’s used to find joy in their work. These pathways, summarized below,closely match Herzberg’s and Maslow’s theories of motivation.

• Connections Pathway. This pathway is based on relationships. This was theprimary source of joy for all participants in the study. This relationship con-nection occurred with colleagues, patients, and families. Caring for, talkingwith, relating to, and helping others exemplified this pathway to joy.


Personal pathway via connectionsLove of work pathway via the work itselfAchievement pathway via goal accomplishment and attainmentRecognition pathway via acknowledgement of good work by others

Pathways to JoyDisplay 18.4

• Love of Work Pathway. This is the pathway that is based on the joy foundin ones work itself. There was a strong connection and identification withthe work that resulted in excitement and enthusiasm that brought joy to theparticipants.

• Achievement Pathway. Achievement, accomplishments, and positive workoutcomes brought joy to some participants in the study. There was a sense ofpride for a job well done, or for being a successful change agent. Personalassessment of achievement was also more important than external rewardsfor achievement.

• Recognition Pathway. Recognition and appreciation also brought peoplejoy in their work. The recognition could be attained through a patient’sgratitude, patient’s families appreciation, or though praise or thanks fromcolleagues, or the organization.

STRATEGIES FOR CREATING A MOTIVATING CLIMATE

In addition to providing a climate that promotes joy in people’s work, theleader–manager can do many other things that create an environment that is moti-vating. Sometimes fostering a subordinate’s motivation is as simple as establishinga supportive and encouraging environment. The cost of this strategy is only themanager’s time and energy. The strategies outlined in Display 18.5 should be usedconsistently to create a motivating climate.


1. Have clear expectations for workers, and communicate these expectations effectively.2. Be fair and consistent when dealing with all employees.3. Be a firm decision maker using an appropriate decision-making style.4. Develop the concept of teamwork. Develop group goals and projects that will build a

team spirit.5. Integrate the staff’s needs and wants with the organization’s interests and purpose.6. Know the uniqueness of each employee. Let each know that you understand his or

her uniqueness.7. Remove traditional blocks between the employee and the work to be done.8. Provide experiences that challenge or “stretch’’ the employee and allow opportunities

for growth.9. When appropriate, request participation and input from all subordinates in decision

making.10. Whenever possible, give subordinates recognition and credit.11. Be certain that employees understand the reason behind decisions and actions.12. Reward desirable behavior; be consistent in how you handle undesirable behavior.13. Let employees exercise individual judgment as much as possible.14. Create a trustful and helping relationship with employees.15. Let employees exercise as much control as possible over their work environment.16. Be a role model for employees.

Strategies to Create a Motivating ClimateDisplay 18.5

PROFESSIONAL SUPPORT SYSTEMS FOR THE MANAGER

Managers also can create a motivating climate by being a positive and enthusiasticrole model in the clinical setting. Managers who frequently project unhappiness tosubordinates contribute greatly to low unit morale. A burned-out, tired managerwill develop a lethargic and demotivated staff. Therefore, managers must constant-ly monitor their own motivational level and do whatever is necessary to restoretheir motivation to be a role model to staff.

Managers must be internally motivated before they can motivate others. It isimperative that discouraged managers acknowledge their own feelings and seekassistance accordingly. Managers are responsible to themselves and to subordinatesto remain motivated to do the best job possible.

Nursing is a stressful profession, and managers must practice health-seekingbehaviors and find social supports when confronted with stress or else risk burnoutas a result. Burnout is defined as “a syndrome of emotional exhaustion, depersonal-ization, and reduced personal accomplishment which happens as a result of thechronic emotional strain of working extensively with other human beings, particu-larly when they are troubled’’ (Schwab, 1996, p. 172). Kalliath and Morris (2002)found that the degree of job satisfaction was the greatest predictor of burnout.


Write a Detailed Plan to Motivate—Quickly!You are the manager of a medical unit in a community hospital. The hos-pital has faced extreme budget cuts during the last five years as a result indecreased reimbursement. Your unit used to be a place that nurses want-ed to work and you rarely had openings for long, even though it was nec-essary for the hospital to contain costs and shorten nursing care hours perpatient day. However recently there has been a severe nursing shortage inyour community and it seems to have accelerated worker dissatisfaction inyour staff.

In the last week, five of the unit nurses, all excellent long-time employ-ees, have stopped by your office either in tears, anger, or frustration andhad various comments, including: “Working here is no longer fun,’’ “Iused to love my job,’’ “I am tired of working with incompetent people,’’and “I am sick to death of calling for supplies that should be stocked onthe floor.’’

You know that there will not be more funding in the near future, butyou feel that perhaps there are things you could do to make the situationbetter for your staff.Assignment: In examining the strategies for creating a motivating climateand the atmosphere that supports finding joy in work, decide what you asan individual unit manager can do to provide a more positive work envi-ronment. Don’t just take things from the list in Display 18.5, but write adetailed plan that is feasible, and one you could begin implementing fair-ly quickly, that would have the potential to turn this situation around.

Learning Exercise 18.5A

The attitude and energylevel of managersdirectly affect theattitude and productivityof their employees.

Garrett and McDaniel’s (2001) research suggests that environmental uncertaintyis positively associated with burnout in nurses and that social climate in a workplaceis negatively associated with burnout. Thus, they conclude that social networks areimportant during times of change and uncertainty in the work environment; inother words, a supportive workplace can protect against burnout.

Burnout and other forms of work-related stress are related to negative organiza-tional outcomes such as illness, absenteeism, turnover, performance deterioration,decreased productivity, and job dissatisfaction. These outcomes cost the organiza-tion and impede quality of care.

Perhaps the most important strategy for avoiding burnout and maintaining ahigh motivation level is self-care. Ellis (2000) defines self-care as caring for yourselfphysically, mentally, and spiritually to maximize your potential. Self-care gives themanager personal insight, which increases his or her self-esteem and self-efficacy.

For self-care, the manager should seek time off on a regular basis to meet person-al needs, have recreation, form relationships outside the work setting, and have fun.Friends and colleagues are essential for emotional support, guidance, and renewal. Aproper diet and exercise are important to maintain physical health as well as emo-tional health. Finally, the manager must be able to separate his or her work life andpersonal life; the manager should remember that there is life outside of work, andthat time should be relished and protected. Ellis (2000) suggests that writing a self-care contract is one way to put a commitment for self-care into motion. Ultimately,the decision to practice self-care rests with each and every nurse.

INTEGRATING LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN MOTIVATING

Most human behavior is motivated by a goal the person wants to achieve. Identify-ing employee goals and fostering their attainment allow the leader to motivateemployees to reach personal and organizational goals. The motivational strategythe leader uses should vary with the situation and the employee involved; it may beformal or informal. It also may be extrinsic, although because of a limited formalpower base, the leader generally focuses on the intrinsic aspects of motivation.

The leader also must be a listener, supporter, or encourager to the discouragedemployee. Perhaps the most important role the leader has in working with thedemotivated employee, however, is that of role model. “When we feel strong phys-ically, mentally, spiritually, and emotionally, we have the energy to create the pas-sion that drives excellence. When we don’t, we aren’t able to renew and recover theenergy necessary to perform at our desired level’’ (Kerfoot, 2001, p. 126). Leaderswho maintain a positive attitude and high energy levels directly and profoundlyaffect the attitude and productivity of their followers.

When creating a motivating climate, the manager uses formal authority toreduce dissatisfiers at the unit level and to implement a reward system that reflectsindividual and collective value systems. This reward system may be formalized, or itmay be as informal as praise. Managers, by virtue of their position, have the ability


to motivate subordinates by “stretching’’ them intermittently with increasingresponsibility and assignments they are capable of achieving. The manager’s role,then, is to create the tension necessary to maintain productivity while encouragingsubordinates’ job satisfaction. Therefore, the success of the motivational strategy ismeasured by the increased productivity and benefit to the organization and by thegrowth in the person, which motivates him or her to accomplish again.

❊ Key Concepts

• Because human beings have constant needs and wants, they are always moti-vated to some extent. However, human beings are motivated differently.

• Managers cannot intrinsically motivate people because motivation comes fromwithin the person. The humanistic manager can, however, create an environ-ment in which the development of human potential can be maximized.

• Maslow stated that people are motivated to satisfy certain needs, rangingfrom basic survival to complex psychological needs, and that people seek ahigher need only when the lower needs have been predominantly met.

• Skinner’s research on operant conditioning and behavior modificationdemonstrates that people can be conditioned to behave in a certain waybased on a consistent reward or punishment system.

• Herzberg maintained that motivators, or job satisfiers, are present in thework itself and encourage people to want to work and to do that work well.Hygiene or maintenance factors keep the worker from being dissatisfied ordemotivated but do not act as true motivators for the worker.

• Vroom’s expectancy model says that people’s expectations about their environ-ment or a certain event will influence their behavior.

• McClelland’s studies state that all people are motivated by three basicneeds: achievement, affiliation, and power.

• Gellerman states that most managers in organizations overmanage, makingthe responsibilities too narrow and failing to give employees any decision-making power or to stretch them often enough.

• Douglas McGregor shows the importance of a manager’s assumptionsabout workers on the intrinsic motivation of the worker.

• There appears to be a perceived threshold beyond which increasingreward incentives results in no additional meaning or weight in terms of productivity.

• Positive reinforcement is one of the most powerful motivators the managercan use and is frequently overlooked or underused.

• The supervisor’s or manager’s personal motivation is an important factoraffecting staff ’s commitment to duties and morale.

• Managers should network with a professional support system for positivereinforcement, information, and guidance in their professional development.

• The success of a motivational strategy is measured by the increased produc-tivity and benefit to the organization and by the growth in the person,which motivates him or her to accomplish again.


More Learning Exercises and Applications


Create a Plan to Remotivate a New EmployeeYou are a county public health coordinator. You have grown concernedabout the behavior of one of the new RNs assigned to work in theagency. This new nurse, Sally Brown, is a recent graduate of a local BSNprogram. Sally came to work for the agency immediately after her gradu-ation six months ago. For the first few months, Sally appeared to beextremely hard working, knowledgeable, well liked, and highly motivat-ed. Recently, though, several small incidents happened to Sally. The med-ical director of the agency became very angry with her over a minormedication error she had made; Sally was already feeling badly about thecareless error. After this episode, a different patient’s husband began dis-liking Sally for no discernible reason; he then refused to allow Sally tocome into their home to care for his wife. Then two weeks ago, a diabeticpatient died fairly suddenly from renal failure, and although no one wasto blame, Sally apparently believed that if she had been more observantand skilled in assessment, she would have picked up the subtle changes inthe patient’s condition sooner.

Although you have been supportive of Sally, you recognize that she is in danger of becoming demotivated. Her once-flawless appearance nowborders on being unkempt; she is frequently absent from work; and heronce-pleasant personality has been exchanged for withdrawal from hercoworkers.Assignment: Using your knowledge of new role identification, assimila-tion, and motivational theory, develop a plan to assist this young nurse.What can you do to provide a climate that will remotivate her anddecrease her job dissatisfaction? Explain what you think is happening tothis nurse and the rationale behind your plan. Your plan should be realis-tic in terms of the time and energy you have to spend on one employee.Be sure to identify the responsibilities of the employee as well.



A Nursing Officer’s DilemmaYou are the chief nursing officer of County Hospital. Dr. Jones, a cardiolo-gist, has approached you about having an ICU/CCU nurse make roundswith him each morning on all the patients in the hospital with a cardiac-related diagnosis. He believes this will probably represent a 90-minutecommitment of nursing time daily. He is vague about the nurse’s exactrole or purpose, but you believe there is great potential for better andmore consistent patient education and care planning.

Beth, one of your finest ICU/CCU nurses, agrees to assist Dr. Jones. Bethhas always wanted to have an expanded role in teaching. However,because of personal constraints, she has been unable to relocate to a larg-er city where there are more opportunities for teaching. You warn Beththat it might be some time before this role develops into an autonomousposition, but she is eager to assist Dr. Jones. The other ICU/CCU staff agreeto cover Beth’s patients while she is gone, although it is obviously anextension of an already full patient load.

After three weeks of making rounds with Dr. Jones, Beth comes to youroffice. She tearfully reports that rounds frequently take two to three hoursand that making rounds with Dr. Jones amounts to little more than “carry-ing his charts, picking up his pages, and being a personal handmaiden.’’ Shehas assertively stated her feelings to him and has attempted to demonstrateto Dr. Jones how their allegiance could result in improved patient care. Shestates that she has not been allowed any input into patient decisions and isfrequently reminded of “her position’’ and his ability to have her removedfrom her job if she does not like being told what to do. She is demoralizedand demotivated. In addition, she believes that her peers resent having tocover her workload because it is obvious that her role is superficial at best.

You ask Beth if she wants you to assign another nurse to work withDr. Jones, and she says that she would really like to make it work butdoes not know what action to take that would improve the situation.

You call Dr. Jones, and he agrees to meet with you at your office when hecompletes rounds the following morning. At this visit, Dr. Jones confirmsBeth’s description of her role but justifies his desire for the role to continueby saying, “I bring $10 million of business to this hospital every year in cardi-ology procedures. The least you can do is provide the nursing assistance I amasking for. If you are unable to meet this small request, I will be forced toconsider taking my practice to a competitive hospital.’’ However, after fur-ther discussion, he does agree that eventually he would consider a slightlymore expanded role for the nurse after he learns to trust her.Assignment: Do you meet Dr. Jones’ request? Does it make any differencewhether Beth is the nurse, or can it be someone else? Does the revenueDr. Jones generates supersede the value of professional nursing practice?Should you try to talk Beth into continuing the position for a whilelonger? While trying to reach a goal, people must sometimes endure adifficult path, but at what point does the means not justify the end? Berealistic about what you would do in this situation. What do you perceiveto be the greatest obstacles in implementing your decision?



To Work or Not to Work?You are a nurse in a long-term care facility. The facility barely meets mini-mum licensing standards for professional nursing staffing. Althoughagency recruiters have been actively seeking to hire more licensed staff,pay at the facility for professional staff is less than at local acute care hos-pitals and the patient–nurse ratio is significantly higher. There appears tobe little chance of improving the RN staffing mix in your agency in thenear future. The nursing administrator is extremely supportive of thestaff’s efforts but can do little to ease the current workload for licensedstaff, other than to turn away patients or close the agency. As a result, allthe nurses on the unit have been working at least 48 hours per week dur-ing the last six months; many have been working several double shiftsand putting in many overtime hours each pay period.

Morale is deteriorating, and the staff has begun to complain. Most ofthe licensed staff are feeling burned out and demotivated. Many havestarted refusing to work extra shifts or do overtime. You feel a responsi-bility to the patients, community, and organization and have continued towork the extra hours but are exhausted.

Today is your first evening off in six days. At 2 P.M., the phone rings,and you suspect it is the agency calling you to come in to work. Youdelay answering while you decide what to do. The answering machineturns on, and you hear your administrator’s voice. She says that they aredesperate. Two new patients were admitted during the day, and thefacility is full. She says she appreciates all the hours you’ve been workingbut needs you once again, although she is unable to give you tomorrowoff in compensation. You feel conflicting loyalties to the unit, patients,supervisor, and yourself.Assignment: Decide what you will do. Will you agree to work? Will youreturn the administrator’s telephone call, or pretend you are not home?When do your loyalties to your patients and the organization end andyour loyalties to yourself begin? Is the administrator taking advantage ofyou? Are the other staff being irresponsible? What values have played apart in your decision making?



Remotivating OneselfYou are a school nurse and have worked in the same school for two years.Before that time, you were a staff nurse at a local hospital working inpediatrics and later for a physician. You have been an RN for six years.

When you began your job, it was exciting. You believed you werereally making a difference in children’s lives. You started several goodhealth promotion programs and worked hard upgrading your healthaides’ education and training.

Several months ago, funding for the school was drastically cut, and severalof your favorite programs were eliminated. You have been very depressedabout this and lately have been short-tempered at work. Today, one of yourbest health aides gave you her two-week notice and said, “This isn’t a goodplace to work anymore.’’ You realize that many of the aides and several ofthe schoolteachers have picked up your negative attitude.

There is much you still love about your job, and you are not sure if thebudget problems are temporary or long term. You go home early todayand contemplate what to do.Assignment: Should you stay in this job or leave? If you stay, how can youget remotivated? Can you remotivate yourself if the budget cuts are longterm? Make a plan about what to do.


Web Links

Understanding Human Motivationhttp://www.utoledo.edu/~ddavis/maslow.htmProvides a synopsis about the work of Abraham Maslow.

Landmark Education—Motivationhttp://www.landmarkeducation.comThe Landmark Forum is a collaborative seminar focused on motivation.

Motivation Theory—The Theorists and Their Theorieshttp://www.accel-team.com/motivation/theory_01.html andhttp://www.accel-team.com/motivation/theory_02.htmlReviews the work of theorists Simon, McGregor, Maslow, Herzberg, Argyris, Likert,Luthans, Vroom, Mayo, and McClelland.


Downsizing Panic and AnxietyAs the result of rising costs and shrinking reimbursement, many hospitalsdownsized their staffs in an effort to shrink costs. Because the hospitalwhere you are the chief nursing administrator is faced with mandatorystaffing ratios, it is impossible to cut further staff nurse positions andmeet requirements for state licensing.

Therefore, the CEO of the hospital has mandated that managementpositions be reduced by 30% throughout the hospital. The CEO hasdecided that department heads can reduce management positions byany method they choose as long as it is done in six months. Job dutiesare to be reassigned among the remaining managers.

This affects you significantly, as nursing has more managers than anyother department. It does not appear that attrition, or turnover, rates inthe next months will be adequate to eliminate the need for some reas-signments, demotions, or termination of your group of 17 managers.This includes both house supervisors and unit managers.

The news travels rapidly through the hospital grapevine. Semi-hysteriaprevails, with many managers consulting you regarding whether theirposition is in jeopardy and what they can to do to increase the likelihoodof their retention. Morale is rapidly plummeting, and relationships arebecoming increasingly competitive rather than cooperative.Assignment: Determine how you will handle this situation. What strate-gies might you implement to reduce the immediate anxiety level? Whatadvice can you give to staff who may face either a layoff or a demotion? Isit possible to preserve the morale of your mangers in an uncertain situationsuch as this?


Theories About the Need for Achievementhttp://mentalhelp.net/psyhelp/chap4/chap4j.htmA psychological self-help site dedicated to the achievement needs to succeed and excel.

Strategies for Lifehttp://www.yourbestyear.comOffers proven methods for setting and achieving your goals for the coming year.

ReferencesAndrica, D. C. (2000). Employee satisfaction. Nursing Economic$, 18(6), 307.Ellis, L. L. (2000). Have you and your staff signed self-care contracts? Nursing Management,

31(3), 47–48.Friedrich, B. (2001). Staying power: First-line managers keep nurses satisfied with their

jobs. Nursing Management, 32(7), 26–28.Garrett, D. K., & McDaniel, A. M. (2001). A new look at nurse burnout. Journal of Nursing

Administration, 31(2), 91–96.Gellerman, S. W. (1968). Management by motivation. American Management Association.Herzberg, F. (1977). One more time: How do you motivate employees? In L. Carroll, R.

Paine, & A. Miner (Eds.), The management process (2nd ed.). New York: Macmillan.Kalliath, T. & Morris, R. (2002). Job satisfaction among nurses: A predictor of burnout levels.

Journal of Nursing Administration, 32(12), 648–654.Kerfoot, K. (2001). The art of raising the bar. Nursing Economic$, 19(3), 125–128.Lee, L. A. (2000). Buzzwords with a basis. Nursing Management, 31(10), 25–27.Levin, P. M. (2001). The loyal treatment. Nursing Management, 32(1), 17–20.Manion, J. (2003). Joy at work! Creating a positive workplace. Journal of Nursing Admin-

istration, 33(12), 652–659.Maslow, A. (1970). Motivation and personality (2nd ed.). New York: Harper & Row.Mayo, E. (1953). The human problems of an industrialized civilization. New York: Macmillan.McClelland, D. C. (1971). Assessing human motivation. Morristown, NJ: General Learning

Press.McGregor, D. (1960). The human side of enterprise. New York: McGraw-Hill.Peters, T., & Waterman, R. H. (1982). In search of excellence. New York: Harper & Row.Prothero, M. M., Marshall, E. S., Fosbinder, D. M., & Hendrix, L. J. (2000). Personal values

and work satisfaction. Registered nurses working in hospitals. Image-Journal of NursingScholarship, 32(1), 81–82.

Schwab, L. (1996). Individual hardiness and staff satisfaction. Nursing Economic$, 14(3),171–173.

Skinner, B. F. (1953). Science and human behavior. New York: Free Press.Vroom, V. (1964). Work and motivation. New York: John Wiley and Sons.Vaughn, G. R. M. (2003). Motivators get creative. Nursing Management, 34(4), 12–14.

BibliographyAsselin, M. E. (2003). Motivating LPNs. Nursing Management, 34(8), 40–45.Cohen, S. (2003). Manager’s fast track. Motivation: Your key IC ingredient. Nursing

Management, 34(6), 10.Fletcher, C. E. (2001). Hospital RN’s job satisfactions and dissatisfactions. Journal of

Nursing Administration, 31(6), 324–331.


Goggin, M. (2000). I’m behind you! The manager as coach. Nursing Economic$, 18(3),160–161.

How motivated are you? (2001). Training, 38(3), 32–33.Fenner, K. (2003). Workforce management. Thriving during a nursing crisis:

Part III: Adding the contributions of individual staff nurses. Journal of Clinical Systems Management, 5(5), 14–15.

Joshua-Amadi, M. (2003). A study in motivation: Recruitment and retention in the NHS.Nursing Management, London, 9(9), 14–19.

Kerfoot, K. (2000). Leadership: Creating a shared destiny. Nursing Economic$, 18(5),263–264.

Laschinger, H. K. S., Finegan, J., & Shamian, J. (2001). Promoting nurses’ health: Effect ofempowerment on job strain and work satisfaction. Nursing Economic$, 19(2), 42–52.

Mahoney, J. (2000). The importance of job satisfaction in retaining nurses. Home HealthcareNurse Manager, 4(1), 28–30.

McGirr, M., & Bakker, D. A. (2000). Shaping positive work environments for nurses:The contributions of nurses at various organizational levels. Canadian Journal ofNursing Leadership, 13(1), 7–14.

Prencipe, L. W. (2001). Reenergize the disengaged worker. InfoWorld, 23(16), 95–99.Schrage, M. (2001). Actually, I’d rather have that favor than a raise. Fortune, 143(8), 412.


18

Documents

Transcript of 18