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Barriers to Nursing Job Motivation

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 Research Journal of Biological Sciences 3 (4): 426-434, 2008
ISSN: 1815-8846
© Medwell Journals, 2008

Barriers to Nursing Job Motivation

1
Khodayar Oshvandi, 1Vahid Zamanzadeh, 2Fazlollah Ahmadi,
3
Eskandar Fathi-Azar, 4Denis Anthony and 4Tina Harris
1
Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
2
Department of Nursing, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
3
Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
4
Mary Seacole Research Centre, Faculty of Health and Life Sciences,
De Montfort University, Leicester, UK

Abstract: Nurses are the largest professional group within hospitals. The lack of Nursing Job Motivation (NJM)
has a negative effect on the health and safety of clients. There are issues in work disinterestedness and job
dissatisfaction among nurses. This research presents the findings of a study exploring the barriers to NJM
among Iranian nurses. This study was situated within the grounded theory method. Participants were 19 Iranian
registered nurses working in some hospitals in Tabriz and Hamadan in Iran. Through data analysis, several main
themes emerged to describe the factors that hindered NJM. Nurses in this study identified job difficulty,
powerlessness and lack of authority, low income, harassment and violence to them, lack of support for nurses,
centralized management, physician-centred culture in hospitals, lack of facilities and lack of a clear nursing job
description. Job motivation is essential for enhancing nurses' role, strengthening the professional image,
improving the healthcare system, increasing the quality of caring and the individual and community health. To
maximize primary health care effectiveness, health workers especially nurses must be motivated. It can be
facilitated by eliminating barriers to job motivation.

Key words: Grounded theory, job motivation, nursing, barriers, NJM

INTRODUCTION moving them toward an independent, self regulated,

Motivation is used as a term to describe the process
of activating human behavior. It implies a sense of
movement, excitement and expectancy. It encompasses a
concern with what energizes behavior, directs or channels
behaviour and maintains or sustains behaviour. Thus
motivation is a catalyst to move individuals toward goals
(Huber, 2000).
Nurses are the largest professional group within
health service organizations (World Health Organization,
2002). Nurses are one of the most important, if not
the most important, human resource of hospitals and
other health-care organizations. Their influence on
organizational performance is abundantly clear
(Hampton and Hampton, 2004; Thierry, 2002). Nurses
represent the largest category of health workers and
provide 80% of direct patient care (Antrobus, 1997).
They are expected to provide good quality of care
through nursing diagnosis, treating human responses
to health and illness and empowering their clients by
healthy life (Adib et al., 2004).
The nature of nursing activities causes employees to
perform their tasks with love and interest. Thus, nursing
interventions have a close relationship to patients’ life;
the lack of job motivation in nurses has a very bad effect
on the health and safety of clients (Heroabadi and
Marbaghi, 1996). Unfortunately, in spite of several
scientific theories about motivation and nature of
human and human needs, there are issues in work,
disinterestedness and job dissatisfaction among
employees. This is supported by many studies, such as
the study of Bjorvell and Brodin (1992) who found that
half of the nursing staff wanted to quit their jobs. Those
nurses, who intended to quit, perceived themselves as
less satisfied with several aspects, than did those who did
not have any intention to quit (Bjorvell and Brodin, 1992).
Collins et al. (2000) reported that more than one
of four nurses in the UK agreed with the statement
that they would leave their profession if they could.
In a study by Gardulf et al. (2005) the authors concluded

Corresponding Author: Khodayar Oshvandi, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz,
Iran
426
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
that about half of the responding nurses intended to
quit their job. The main reasons for this were
dissatisfaction with the salary and psychologically
strenuous and stressful work.
There is evidence that job stress and job
dissatisfaction decrease nurses’ work motivation
(Gillies, 1994). Previous studies report that managerial
factors affected employees’ attitudes, job satisfaction,
organizational commitment and motivation to perform well
and these factors, in turn, influenced organizational
outcomes included, for example, patient satisfaction and
employees’ intention to quit (McNeese-Smith, 1996;
Tzeng, 2002).
Trying to fulfill nurses' expectations and maximize
their performance is a challenging task of hospital
managers (Bratton and Gold, 2003) and according to some
experts, a nurse manager’s most important leadership
task is to maximize subordinates’ work motivation
(Gillies, 1994).
Motivation to work is defined as the degree to which
members of an organization are willing to work. There are
energizing forces within individuals that drive them to
behave and environmental forces that trigger the drives
(Huber, 2000).
The nature of job motivation is processing, it is
socially depended and also human interactions have an
important role in its formation, but a quantitative study
will not provide deep understanding of job motivation.
Thus qualitative research is necessary for exploration of
it. Carter and Kulbok (2002) in a review of the nursing
literature, concluded that qualitative research would be
especially helpful for further instrument development and
to validate the meaning and multidimensional composition
of motivation.
Context: Iran, a country of seventy million has a national
health service which employs over 70,000 nursing
personnel who provide nursing care for clients. The
population of nurses is approximately 150,000 but half of
them are unemployed because of constitutional and
economic problems. Paradoxically there is a shortage in
nursing staff which is a serious problem in most hospitals.
Consequently nurses have to work more than their
required shift; with potentially a second shift as overtime
in some parts of the country.
Nursing care in Iran before 1915 was carried out by
household women or servants. Hospitalized patients were
also cared for by untrained personnel. Because of this
history, lack of basic education, low cultural status and
some religious limitations for women, nursing as a
profession/career neither gained high standard nor
recognition. But in 1916 a three-year nursing school was
427
established in Tabriz. After that there was a gradual
increase in nursing schools across the country. The first
university program for obtaining a BSN began in October
1967 at Shiraz University (Adib and Salsali, 2005) and
Master of Science in Nursing (MSN) programs in many
universities gradually developed. The first university
program for obtaining a PhD degree in nursing began in
1996 at Tabriz medical sciences university.
Before the Islamic revolution in 1979, the majority of
nurses were female and cared for both men and women.
After the revolution, the government decreed nursing
schools should allow entry of male students with a target
of 50% of those admitted, according to the belief that men
should care for men and that women provide care for
women. But nursing continues to be considered a female
profession in Iranian culture and the number of male
students in nursing schools has been declined gradually
to less then 20% now.
MATERIALS AND METHODS
This grounded theory study was performed
according to the Strauss and Corbin (1998) method.
Grounded theory has become an important research
method for the study of nursing phenomena. Grounded
theory comprises methods for studying social process
and social structures (Polit and Beck, 2006). It is a form of
field research that explores and describes phenomena in
naturalistic settings such as hospitals, outpatient clinics,
or nursing homes. The purpose of field studies is to
examine in an in-depth fashion the practices, behaviors,
beliefs and attitudes of individuals or groups as they
normally function in real life (Streubert and Carpenter,
1999). Data were collected in individual interviews which
were audiotaped and transcribed and through field notes
which were recorded during interviews.
The main purpose of this study, is to explore the
nature of nursing job motivation as a social process, thus
grounded theory is an appropriate method to analyse data
and explore the nature of nursing job motivation. Results
from this study, might inform how nursing job motivation
might be increased and subsequently increase the quality
of caring and finally increase the individual and
community health.
Participants and data collection: The study comprised of
19 participants who are nurses in varying roles and
settings, they are 13 nurses, 3 supervisors, 2 matrons and
one hospital manager. The participants' age ranged from
24-53. Nursing practice experiences ranged from 1 to 21
years. Eighteen of participants had BS degree in nursing
and one participant had MS degree in nursing. Twelve of
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
participants were female and six were male. Purposive
sampling was used at first and then continued with
theoretical sampling according to the codes and
categories as they emerged. Criteria for selection were
nurses with more than one year of nursing experience and
who worked full-time in some selected educational
hospitals. Any nurse who met this requirement was
considered a potential participant. Data collection began
with staff nurses; after interviewing three nurses and
coding the transcripts, the codes and categories that
emerged were related to job variables, organizational
variables and nursing esteem which led to the decision
for the researcher to interview staff nurses and some
other key informants such as higher-level managers;
supervisors, matrons and a hospital manager. Each
interview session ranged from 30-75 min. Data were
collected and analyzed over one year period from Sep
2005 to Sep 2006 in some educational hospitals of Tabriz
and Hamadan universities of medical sciences in Iran.
Interviews: Semi structured indepth interviewing
continued on all shifts, saturation of the data were
achieved in 19th interview. The main researcher
contacted each of the potential participants and explained
the objectives and the research questions. If the
participant agreed to take part in the research and after
signing the informed consent sheet, they were given an
appointment for the interview. Participants were
interviewed in a private room at the workplace using an
individual semi-structured interview format and this was
primarily the core source for data collection.
The interview guide consisted of open-ended
questions to allow the respondents to explain their own
opinions, perceptions and experiences as completely as
possible. To start, each interview began with a broad
question, such as "could you describe one of your
working shifts?" then asked them to explain their own
experiences, perceptions and opinions of "job
motivation", as well as "barriers and facilitators" that
affected their job motivation.
The interviews continued with the topic questions
and probes in order to capture a deeper understanding of
the phenomenon under study. For instance, participants
were asked, what is the meaning of job motivation in
nursing? Can you describe some of your instances when
you felt motivated in work? Which factors influenced
your experiences of motivation? If it were possible to live
your life again would you choose nursing as a job? What
are your opinions about how you can increase nursing
job motivation? Some field notes were made about the
issues raised during the interview. Interviews were
recorded, then transcribed verbatim and analyzed
consecutively.
428
Data analysis: The data collection and analysis were
done simultaneously according to the grounded theory
approach. Each interview was transcribed verbatim and
analyzed before the next interview took place; therefore
each interview provided a direction for the next. The
process of interviewing was stopped when data
saturation occurred. Data were considered "saturated"
when no more codes could be identified and the category
was "coherent" or made sense.
Open, axial and selective coding was applied to data
(Strauss and Corbin, 1998). First-level codes or open
codes, are those in which small portion of data are
conceptualized, using the participant's words as much as
possible (Schreiber and Stern, 2001). Through open
coding, each transcript of an interview was reviewed
several times and the data reduced to the codes. Then the
categories were formed from the codes, in a manner such
that similar codes were grouped into the same categories
(Strauss and Corbin, 1998). Second-level codes are more
abstract and present a synthesis of first-level codes
(Schreiber and Stern, 2001). The focus of axial coding was
on specifying a category in the context in which it had
appeared. Codes that were found to be conceptually
similar in nature or related in meaning were grouped in
categories. The categories and codes from each interview
were compared with other interviews in order to identify
common links. Categories were related to their
subcategories in axial coding. Coding occurred around the
axis of a category, linking categories at the level of
properties and dimensions (Strauss and Corbin, 1998). At
this stage the structures of categories were related to the
processes. The factors that contributed to nursing job
motivation were identified. This process allowed links to
be made between categories and their subcategories and
then selective coding developed the main categories and
their interrelations.
If the researcher is simply concerned with exploring
or describing the phenomena being studied, axial coding
completes the analysis (Negarandeh et al., 2006).
Therefore, we stopped data analysis at this stage for this
study. However, in grounded theory you had to go on
selective coding. The process of integrating and refining
the theory occurred in selective coding. Selective coding
or Third-level codes hypothesize relationship among the
lower-level codes. First, second and third-level codes can
be understood as concepts, categories and relationship,
respectively (Schreiber and Stern, 2001).
To address trustworthiness, Lincoln and Guba's four
criteria were used. This in quantitative research is
equivalent to empirical positivistic criteria (validity and
reliability). The four trustworthiness criteria are credibility,
confirmability, transferability and dependability (Polit and
Beck, 2006). Regarding trustworthiness, credibility was
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
established through participants' revision, prolonged
engagement of main researcher with participants and peer
check. Maximum variation of sampling also confirmed the
conformability and credibility of data (Polit and Beck,
2006; Streubert and Carpenter, 2003). After data analysis
each participant was contacted and was given a full
transcript of their respective coded interviews with a
summary of the emergent themes to determine whether the
codes and themes were in accord with their experience. As
a further validity check, two expert supervisors and two
other doctoral students of nursing did peer checking. The
transcripts of interviews were given to each of the above
people and they followed the same process and arrived at
similar core themes. There was high agreement between
different raters.
Prolonged engagement with the participants within
the research field allowed the main researcher to gain the
participants' trust and better understanding of the
research fields. Maximum variation of sampling (in terms
of the type of ward, years of working experience and place
of duty) also enhanced the confirmability and credibility
of data. This sampling strategy enabled the researcher to
capture a vast range of views and experiences (Manongi
et al., 2006). The researcher attempted to have precise
documentation of the direction of the research and
decisions made to save the "auditability" that will make it
easier for other researchers to follow the direction of the
research. Furthermore, results were checked with some of
nurses who did not participate in the study and they
confirmed the fitness of the results.
Ethical considerations: This study is a part of a PhD
thesis in Tabriz Medical Sciences University. Ethical
issues in this study involved the assurance of autonomy,
confidentiality and anonymity of the participants. All
participants were informed of the purpose and design
of the study and also the voluntary nature of their
participation. The ethics committee of Tabriz University of
Medical Sciences approved the research proposal.
Informed consent was attained from all of the participants
for the study and audiotaped interviews. Permission was
attained from the hospital director, nursing manager and
head nurses in order to conduct the study.
RESULTS
Through the process of data analysis, several
categories emerged that explain the process of nursing job
motivation and factors that act as barriers to nursing job
motivation. The themes reflecting the barriers to nursing
job motivation are shown in Table 1.
429
Table 1: Themes related to barriers to nursing job motivation
Job difficulty Centralized management
Powerlessness and lack of authority Physician-centred culture in hospitals
Low income Lack of facilities
Harassment and violence Lack of clear job description
Lack of support
Barriers to nursing job motivation: Participants cited
job difficulty as a key barrier to job motivation. Some of
the Participants illustrate this theme, such as nurse 2 who
said:". When my family is going to go to the promenade
or party, I could not attend, Because of working in
holidays and night shift. Nursing job responsibility is
not compatible with our private life ". Or nurse 6 said:
Nursing shortage causes work overload and fatigue…"
and nurse 7 said, "our working hours are very high,
especially for women who also must do a lot of task
in home".
According to the participants, powerlessness and
lack of authority act as a barrier to job motivation. Two
nurses stated "A powerful nurse is one who has good
knowledge and can use it well" and "The power of a nurse
depends on their knowledge and skills as well as
application of them in the care for their clients." In
addition, participants pointed out that the culture and
structure of the organization negatively impacts nurses'
authority and it is one that emphasizes "physician
centredness". One participant cited that "I must have the
right to do nursing care based on my diagnosis, but I
haven't this authority now, "a person can be powerful
only when he/she can decide on his/her own." Others
pointed out that "the public hasn't an appropriate view on
the nursing profession", "we are only expected to do the
physicians orders," all these variables minimized their
ability to exercise authority or power in the practice
setting.
Several nurses noted that low income acts as barrier
to their job motivation. Comments that reflected this
included nurse 2 who said:" Although we work a lot, our
income is very low, if it was some more, it could more
energize us". Similarly nurse 5 and nurse 8 said:"… our
salary is not sufficient for our life, thus we had to do an
extra shift for more income". Nurse 9 added: " if our salary
were sufficient, we can do our duty with high quality
because our minds are free and we can concentrate on our
clients' problem not our financial problems".
Harassment and violence to nurses is another
barrier to nursing job motivation. Some of participants
illustrate this code. Nurse 7 said: "our previous
hospital manager ill-treated us so much that I wished to
go on leave without pay for 6 months and didn't come
to hospital until he was replaced". Nurse 11 said
"hospitals' managers did not appreciate us; they were
not responsive to our needs". Nurse 16 noted: "when the
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
EKG doesn't work or there isn't some necessary
equipment the patients' carers think this is our fault and
insult us".
Lack of support for nurses was identified as another
job motivation barrier. Participants felt that they did not
receive any support from hospital managers. Nurse 8
states"… when a problem occurs for a nurse, there isn't
any financial or psychological support from hospital
management's team for him/her". Or nurse 10 said :"one of
our coworkers was injured by a patient's carer, but
hospital managers said that we couldn't support you, you
must complain as a personal issue”. One of the hospital
manager stated, "unfortunately there isn't any law to
support nurses".
Centralized management is another item which acts as
a barrier to nursing job motivation. Some of informants
such as nurse 11 said: "we were not consulted in decision
making by them (managers of hospital), they impose their
decisions to us". Or nurse 15 noted: "Nursing managers
who have a key position are far from nurses' problems and
can not perceive our problems". Nurses 12 and 5 stated:
"They (hospital managers) not only didn't let us
participate in decision making regarding our ward, but
also didn't conduct an opinion poll of us about our
monthly shift schedule".
Physician-centered culture in hospitals, the culture
and structure of the health care system was another
important factor that inhibited nursing job motivation.
When nurses are part of an organization that is
"physician centered" they are almost ignored. One nurse
manager noted: because of some cultural and
organizational factors the nurses’ capabilities are not use
appropriately. Some of others said: "The health care
system is at hands of the physicians," "all of the top
managers of health care system and also in hospitals are
the physicians," "nurses are only considered as tools
for carrying out the physicians' orders."
Informants also noted that lack of facilities for them
is another barrier to their job motivation. Examples include
the following, nurse 7 and 18 said: "if we go on a trip
there aren't any facilities such as accommodation for us,
but in all of the cities there is special provision
(Teacher Home) for teachers". Nurse 4 cited: "some of
my friends that work at the Ministry of Finance have a lot
of facilities such as monthly rewards, season rewards and
accommodation in tourism cities". Some nurses said:
"there isn't any scholarship for us in overseas countries
such as doctors to learn new procedures and care
methods".
Lack of clear job description for nurses is another
barrier to job motivation. Some of the participants such as
nurse 14 said: "there isn't any clear job description for us,
If our hospital or even our ward changed we must do very
430
different tasks", or nurse 12 and 17 stated that: "there
are no differences between job descriptions for BS
in nursing and Diploma in nursing (Behyar) or MS in
nursing", nurse 11 said: "I know that in some hospitals
the diplomate in nursing (Behyar) is supervisor but the
MS educated nurse is working as a staff nurse".
DISCUSSION
All nurses that participated in this study believed
that job motivation is one of the most important factors to
perform suitable and effective care for patients. In the
nursing literature motivation is considered as a catalyst to
move individuals toward goals and encompasses a
concern with what energizes behavior, directs or
channels behavior and maintains or sustains behavior
(Huber, 2000).
The data arising from this study, provide evidence of
the barriers to the job motivation process. In this study,
many barriers to nursing job motivation from Iranian
registered nurses' perspectives were determined. The
factors that were identified as barriers to job motivation
by the participants were job difficulty, powerlessness and
lack of authority, low income, harassment and violence to
nurses, lack of support for nurses, centralized
management, physician-centred culture in hospitals, lack
of facilities and lack of a clear nursing job description.
These findings were congruent with literature that
describes the factors which influence motivation to job.
Job difficulty: A study of Manongi et al. (2006) showed
that from the viewpoint of service providers, the main
factors identified that caused demotivation among health
care workers working at Primary Health Care (PHC)
facilities were workload paired with staff shortages, lack
of interprofessional exchange and lack of positive
supervision, including transparent career goals. Physical
infrastructure and equipment available to staff in the
PHC setting did sometimes affect morale-and
certainly services -but overall the findings from these
focus-group discussions indicate a need for individual
staff to feel valued and supported and to develop in their
roles.
Powerlessness and lack of authority: In study of Adib
et al. (2004) data were examined to identify the core
variable influencing the nurses' power. A careful review of
the data and the themes that emerged proves that
"organizational culture and structure" was the core
variable affecting nurses' power. In fact, it was the
organizational structure and its physician-centred and
routine-oriented culture that have made nurses just
obey doctors and managers and carry out their orders.
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
Low income: It seems that some preoccupations of the
nurses such as salary, income and job insecurity have
caused them to remain in the first and second category
of basic needs as described by Maslow, so that they lack
the required motivation and ability for professional
cooperation and progress. This situation has resulted in
a lack of political and professional power, so that in spite
of being the largest group in the health system, they are
considered the weakest discipline (O'Reilly, 1993; World
Health Organization, 2002).
Harassment and violence to nurses: In study of
Ferrinho et al. (2003) showed that some results suggest
differences in the patterns of violence, in the health
facilities studied: verbal violence is most frequent against
Health Centre (HC) nurses and administrative personnel;
physical violence seems most frequent against nurses in
both the HC and the hospital; sexual harassment seems a
particularly frequent problem of hospital nurses; bullying
/mobbing is most frequent against HC GPs and
administrative personnel; discrimination seems a
phenomenon felt mostly in the hospital by nurses,
other professionals with a university degree and the
"other" category.
Twenty-two official reports on violence from five
HCs and two hospitals were analysed. Most reported
violence was verbal, reflecting the results of the hospital
and the HC study. But, taking the HC complex case
study as the standard, HC administrative personnel and
nurses seem to underreport violence against health
professionals in the workplace when compared to doctors
(Ferrinho et al., 2003).
Lack of support for nurses: Manongi et al. (2006)
showed that, health workers complained that their
supervision was not systematic-and was not supportive
when provided. Several studies have shown that joint
problem-solving between supervisors and health workers
is essential for quality improvement and job satisfaction
(Ahmed et al., 1993; Loevinsohn et al., 1995).
Davis et al. (2003) noted in their study, all except one
nurse said that nursing leadership had a responsibility to
help nursing staff to be advocates for patients and
families. All of these nurses noted that physicians had
strong authority and they therefore realized their
vulnerable position in the organizational structure of
health facilities. They believed that without nursing
leadership support for advocacy, patient care and
protection could become secondary to self-protection.
Organizational support: In study of Fort and Voltero
(2004) which asked participants if they had received
431
performance reviews from supervisors, 64% said they
had; in describing the reviews, more than 80% said they
were oral and informal exercises. Supervision visits occur
frequently, according to respondents: 94% of providers
had received a supervisory visit during the previous 6
months. Though supervision was frequent and quite long,
86% of providers characterized supervisors' tasks as
administrative (e.g. "checks forms, vaccinations") and
24% as clinical ("sees patients and works in the clinic").
In less than 10% of responses, the supervisor was said to
have provided feedback on performance.
As MacPhee and Scott (2002) argue, although not all
the factors and working conditions are under the control
of the managers, supporting the nurses can decrease
current pressures on nurses to a considerable extent and
increase the nurses' self-confidence and power. Nurses
expect their managers to provide them with facilities
for care and financial and emotional support, so that
they can take care of their patients with peace of mind
(Tomey, 2000).
When nurses are not provided with such support,
they feel unable to control their working environment;
thus they experience frustration, worthlessness and
powerlessness. On the contrary, when they have such
support, they feel power and authority (Brown, 2002;
East, 2000; Laschinger et al., 2001).
Centralized management: Rushton noted that in
institutions where hierarchal decision making, objectivity,
efficiency and traditional power structures are valued,
there may be incongruence between the stated
philosophy, values and goals of the organization and the
reality of the work place. In such environments, conflicts
related to nurse-physician relationships, institutional
policies and practices, (particularly those that govern
resource allocation and the quality of patient care),
professional behaviors of administrators and colleagues
and job security arises. Effective leadership, open
communication patterns, collaborative problem solving
methods, compatibility of values and philosophy among
various health care team members and procedural
safeguards such as ethics committees facilitate advocacy
and patient outcomes (Rushton, 1995).
Physician-centered culture in hospitals: Davis et al.
(2003) noted in their study, all of nurses noted that
physicians had strong authority and they therefore
realized their vulnerable position in the organizational
structure of health facilities. They believed that without
nursing leadership support for advocacy, patient
care and protection could become secondary to
self-protection.
 Res. J. Biol. Sci., 3 (4): 426-434, 2008
Lack of facilities: It was reported in the study of
Manongi et al. (2006) that the lack of laboratory diagnosis
capacity within the primary health care facilities resulted
in health workers' feeling as if they were gambling with
patients' health. In malaria-endemic areas, access to
microscopic diagnosis is a priority factor in valuing PHC
facilities. However, having both microscopes and
technicians in place at the same time is not always
achievable.
Environment (tools and equipment) and work
organization: Fort and Voltero (2004) in their study asked
if their workplace was adequate, 76% said "yes", although
only 40% said it was "comfortable". Nearly 60% of
providers said they did not have the tools "to do the job
well." When asked what equipment was needed, first aid
medicines (13.5%), surgical instruments (10.5%) and
scales (9.4%) were listed, averaging 2.8 items mentioned
per individual. As a follow-up question on the availability
of equipment and tools, providers were asked if they had
been trained in the use of the clinic tools – nearly 75%
said they had been. The last area explored was whether
the provider was satisfied with the way the work was
organized. Most respondents (75%) answered "yes" to
this question.
Lack of clear nursing job description: In study of Fort
and Voltero (2004) almost 7 of 10 providers lacked job
description; when asked how they knew what to do for
their jobs, 69% answered "through oral explanation from
the supervisor or other person." When providers were
asked whether standards for their performance had been
set (i.e. they were told how they should do their job), 78%
responded affirmatively; in further questioning, 37%
stated having guidelines, 35% other written material and
21% had protocols.
Adib et al. (2004) showed that heavy workloads, staff
shortage and unclear job descriptions were among the
organizational barriers that made them become task-
oriented and made them overlook their authority. Also,
participants in this study complained of the lack of self-
confidence and internalized dependency in nurses and
considered it one of the leading causes of their
powerlessness. Laschinger et al. (2000), Nikbakht et al.
(2003) and Fulton (1997) also have reported that the
nurses feel they have little formal and informal power
and authority (Fulton, 1997; Laschinger et al., 2000;
Nikbakht et al., 2003).
CONCLUSION
Nursing in Iran has been progressive as
evidenced by comparing the history of nursing to
where they are now. Therefore, job motivation is
essential for enhancing nurses' role, strengthening the
432
professional image, continuously improving the
healthcare system nationally and globally and increase
the quality of caring and finally increase the individual
and community health.
This study illustrates the barriers to the NJM from
the Iranian registered nurses' perspectives. Participants in
this study believed that in these circumstances and by
taking into consideration the barriers mentioned, taking a
high job motivation condition is difficult for majority of
them. To maximize primary health care effectiveness,
health workers must be motivated. It can be performing by
eliminating barriers to job motivation. Manongi et al.
(2006) found that although financial incentives are
important, they are not sufficient to motive health worker,
supportive supervision performance appraisal, career
development and transparent promotion have been
prioritized by primary health care facility worker for
improving the services they deliver in Tanzania.
It can be concluded that job motivation is
contextually complex and is a controversial and illusive
component of any nursing practice. Different workplaces
and cultures may affect the findings of the study. This
inquiry is a description of the barriers to NJM the Iranian
nurses' perspective, nurses working in others areas may
have different views, or may experience similar barriers to
NJM. Therefore, additional research studies are needed to
further our understanding of the NJM. It is recommended
that future qualitative and quantitative research be
conducted to identify the other aspects of barriers to
nursing job motivation. In addition specific knowledge
and behaviors that support the nursing job motivation
should be examined.
ACKNOWLEDGEMENT
The authors wish to thank all the nurses and nursing
administrators who contributed in this research. It was
their willingness to share their experiences and insights
that made this study possible. We also extend our
gratitude to Tabriz University of Medical Sciences for its
financial support.
We are very grateful to Professor Mark Johnson
(Director of Mary Seacole Research Centre, DMU) and
Professor Gillian Grant (then Dean of Faculty of Health
and Life Sciences, DMU) for their support in giving a
visiting scholarship to the first author.
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