Relationship between Rewards… Nebiat N 107

ORIGINAL ARTICLE

RELATIONSHIP BETWEEN REWARDS AND NURSES’ WORK

MOTIVATION IN ADDIS ABABA HOSPITALS
Nebiat Negussie

ABSTRACT

BACKGROUND: Nurses constitute the largest human resource element and have a great impact on
quality of care and patient outcomes in health care organizations. The objective of this study was to
examine the relationship between rewards and nurse motivation on public hospitals administrated by
Addis Ababa health bureau.
METHODS: A cross-sectional survey was conducted from June to December 2010 in 5 public hospitals
in Addis Ababa. Among 794 nurses, 259 were selected as sample. Data was collected using self-
administered questionnaire. After the data was collected, it was analysed using SPSS version16.0
statistical software. The results were analysed in terms of descriptive statistics followed by inferential
statistics on the variables.
RESULTS: A total of 230 questionnaires were returned from 259 questionnaires distributed to
respondents. Results of the study revealed that nurses are not motivated and there is a statistical
significant relationship between rewards and the nurse work motivation and a payment is the most
important and more influential variable. Furthermore, there is significant difference in nurse work
motivation based on age, educational qualification and work experience while there is no significant
difference in nurse work motivation based on gender.
CONCLUSION: The study shows that nurses are less motivated by rewards they received while rewards
have significant and positive contribution for nurse motivation. Therefore, both hospital administrators’
and Addis Ababa health bureau should revise the existing nurse motivation strategy.
KEYWORDS: Rewards, Nurses, Motivation, Public Hospitals

INTRODUCTION by employee while intrinsic rewards are intangible

rewards or psychological rewards (3).
Human resource is a vital component for health In Ethiopia, even if the health service
organization in delivering health services (1). organization and management is decentralized,
There are many factors that affect employee there is still a shortage of health professionals in
performance like: work conditions, employee and different disciplines. This has a great deal of
employer relationship, training opportunity, job undesirable impact on efficiency and effectiveness
security, and institution’s overall policies and of the health of the delivery services (4). High
procedures for rewarding employees (2). Among turnover is one of the major factors contributing to
those factors, which affect employees’ shortage of health workers (4). Based on World
performance, motivation that comes with rewards Bank report between 1995 to 2000 in Ethiopia
is of utmost importance (2). Motivation is an 20% of health workers quitted from public
accumulation of different process that influence hospitals and health centres and the first reason for
and direct our behaviour to achieve some specific high attrition rate was low salary (5). The study
goal (3). Rewards can be extrinsic or intrinsic, also revealed that 74.6% of medical doctors,
extrinsic rewards are tangible rewards and these 62.5% of pharmacists, 50.6% of nurses and 34.2%
rewards are external to the job or task performed of laboratory technicians were not satisfied with
their job because of the low remuneration (5).
1
Department of Management, Jimma University. Email: nebitcorsalini@yahoo.com
108 Ethiop J Health Sci. Vol. 22, No. 2 July 2012

Nurses constitute the largest human resource of this research is to examine the relationship
element in the healthcare organizations, and have between rewards and nurse work motivation in
a great impact on the quality of care and patient hospitals administrated by Addis Ababa Health
outcomes (6), but there is a limited amount of Bureau. The study was guided by theoretical
literature in the area of relationship between framework developed by Khan, Farooq and Ullan
rewards and nurse work motivation. The objective (7) ( Fig. 1).

Figure 1. A conceptual model of motivation theory

MATERIALS AND METHODS should have a working experience of more than

one-year and should be a full-time worker.
A cross-sectional survey design using a The dependent variable for this study was
quantitative method was conducted in five work motivation and the independent variables
hospitals (Ras Desta Damtew, Zewditu, Yekatit were rewards (payment, promotion, recognition
12, Menilik II, Gandi Memorial) which are and benefit). The study was used closed ended
administrated by Addis Ababa Health Bureau questioner developed by De Beer (8) and TR
from June to December 2010. The participants of Mitchel (9) to measure the independent and
this study were midwives, clinical, public health, dependent variables. The questionnaire had two
anaesthetic, ophthalmic, dental, psychiatric, and parts. Part one of the questionnaires was
registered nurses who have been working in these developed to obtain biographical information
five hospitals are working in these five hospitals. including: age, gender, educational qualification
A list of 658 nurses meeting the inclusion criteria and work experience. The second part which
for the study was obtained from the Addis Ababa comprises of items regarding two factors of
Health Bureau. The sample size of the study was nurses’ work motivation including: internal
determined by single population proportion (intrinsic) and external (extrinsic) and four
formula assuming, 5% marginal error and variables of rewards: the direction of an
confidence interval of 95%. . Fifty percent employees’ behaviour (Focus), the level of
proportion has been preferred due to lack of employee efforts(intensity), the way employee
similar studies in Ethiopia and accordingly the perform the task(quality), and the individual’s
sample size was calculated to be 384. willingness to behave despite obstacles(duration).
Accordingly, the sample size was calculated to be Five points Lickert scale ranging from 1(strongly
384. The final sample size was calculated by using disagree) to 5(strongly agree) was used to measure
finite population number correction formula and their response. The respondent’s scores for each
considering 20% non- response rate, the final construct were obtained by summing across all the
sample size was 290. A simple random sample item scores of the individual variation. The
was obtained by numbering the subjects from 1 to crombach’s alpha reliability coefficients for the
658 and using a table of random number to obtain subsection of the questionnaire are as follows:
290 subjects. Inclusion criteria for the sample payment(r=0.83), promotion(r=0.84), recognition
were: They should be a worker in hospitals (r=0.88) and benefit(r=0.85). Rehman also
administrated by Addis Ababa Health Bureau, determined the internal consistency of the work
 Relationship between Rewards… Nebiat N 109

motivation questionnaire and he reported that a Ethical clearance was obtained from Addis Ababa
coefficient alpha that is consistently high, ranging Health Bureau ethical review committee, and
from 0.82 to 0.93(10). This suggests that the items permission to conduct the study was obtained
of the questionnaire are relatively homogeneous from Addis Ababa Health Bureau. Verbal consent
with respect to the attitude construct they measure was obtained from every one of the participants
(10) reported (11). before the data collection. Additionally, names of
Data were collected by five diploma holder participants were not used in the study and
nurses after they were provided a thorough confidentially of the respondents’ information was
training on data collection procedure. A strict maintained.
supervision was made by the researcher during the
data collection. Before data collectors delivered RESULTS
the questionnaire to respondents, they had
explained the objective of the research including A total of 230 questionnaires were returned out of
questionnaire returning date. the 290 questionnaires distributed to the
Statistical Package for the Social Sciences respondents which made the response rate 80%.
(SPSS) version 16 software was used for data Most of the participants 98(43.0%) were in
analysis. Descriptive statistics was used for the age group of 20-29 and 168 (73.0%) of them
demographic information. Spearman’s correlation were females. One hundred thirty three (58.0%)
coefficient and incremental regression analysis had a diploma in nursing and over half of them
were used to determine the relationship between 132(57.0%) had a working experience of 1-5 years
rewards (payment, promotion, recognition and (Table 1).
benefits) and nurses’ work motivation.

Table 1. Socio-demographic characteristics of respondents, hospitals administrated by Addis Ababa health

bureau, August 2010.
Sociodemographic Variable Total No. (%)
Age
20-29 98(43)
30-39 49(21)
40-49 60(26)
50-59 23(10)
Gender
Male 62(27)
Female 168(73)
Educational Qualification
Diploma 133(58)
BSc Degree 94(42)
Work Experience
1-5 132(57)
6-10 41(18)
11-15 18(8)
16-20 15(7)
>20 24(10)

The means for the payment, promotion, that nurses are not motivated by the payment,
recognition and benefits ranged from 1.44 to 1.53. promotion, recognition and benefit they receive.
Results of the descriptive statistics in terms of Compare to other independent variables, the mean
arithmetic mean and standard deviation show that value of payment is the lowest and this revealed
the mean values for all the variables are low. Low that nurses are more de-motivated by the payment
mean values of independent variables revealed they receive. Furthermore, Mean value for nurse
110 Ethiop J Health Sci. Vol. 22, No. 2 July 2012

work motivation is 1.41 which show that nurses Spearman’s correlation was performed to study
are not motivated overall (Table 2). the size and magnitude of the relationship between
the variables. The relationships between rewards
Table 2: Descriptive statistics of rewards and (payment, promotion, recognition and benefits)
nurse work motivation in hospitals administrated are positive and significantly related with nurses’
by Addis Ababa Health bureau, August 2010. work motivation (Table 3). Correlation coefficient
between payments and motivation (0.74) is the
Variables Mean Standard highest among the entire variables and significant
Deviation at 99% whereas recognition has a weakest
Payment 1.44 0.74 correlation (0.29) among all variables but
Promotion 1.51 0.72 significant at 95.0% (Table 3).
Recognition 1.53 0.67
Benefits 1.45 0.72
Nurse motivation 1.41 0.73

Table 3. Correlation of payment, promotion, recognition and benefits with nurse work motivation in
hospitals Administrated by Addis Ababa Health Bureau, August 2010.

Variables Motivation Payment Promotion Recognition Benefit

Motivation 1.00
Payment 0.74** 1.00
Promotion 0.34** 0.30** 1.00
Recognition 0.29* 0.25* 0.02 1.00
Benefits 0.56** 0.60** 0.59** 0.47* 1.00
*Correlation is significant at the 0.05 level, **Correlation is significant at the 0.01 level

The increment regression is performed by result also obtained in goodness of fit in

removing individual variables from the model and incremental regression after removing the
by checking the effect on the value of R-squared. payment. This decrease in value of the R-square
Among all the variables removed, payment has by 17% shows the importance of payment in the
decreased the value of R-squared to the highest model.
degree from 79% to 62% (Table 4). The same

Table 4: Incremental Regression of nurse work motivation, hospitals administrated by Addis Ababa Health
Bureau, August 2010.

Variable OLS1 OLS2 OLS3 OLS4 OLS5

Payment 0.71** - 0.77** 0.70** 0.77**
Promotion 0.11** 0.28** - 0.13** 0.12**
Recognition 0.03* 0.11* 0.07 - 0.08*
Benefits 0.10** 0.69** 0.09 0.13** -
R square 0.79 0.62 0.78 0.79 0.78
F-value 211.5** 125.5** 268.5** 282.5** 278.8**
D-W 1.675 1.76 1.66 1.62 1.64
* and ** indicates significance at 0.05, 0.01 level respectively

DISCUSSION that work force is one of the challenges for health

organization in developing countries (16). The
Human resource is considered as the most results from this study reveal that there is
important resource of an organization (2). significant and positive relationship between
Acquiring the right workforce and then retaining rewards and nurse work motivations. Among the
 Relationship between Rewards… Nebiat N 111

independents variables payment is the most ACKNOWLEDGMENTS

significant factor which affects nurses work
motivation while recognition has the weakest I would like to acknowledge the following people:
correlation with nurses’ work motivation. This Costantinos Berhe (PhD), Addis Ababa Health
finding also consistent with findings from other Bureau and all nurses who participated in this
studies where Cashman and Gray found that research.
doctors wanted autonomy and job status above a
high income and regarded extrinsic benefits as REFERENCES
less important while nurses wanted better
monetary compensation more than anything 1. The JLI Africa Working Group. The Health
else(12,13). Other research finding also shows that Workforce in Africa Challenges and
extrinsic rewards have a significant impact on Prospects: A report of the Joint Learning
nurses’ work motivation while intrinsic rewards Initiative on Human Resources for Health and
do not have much significant impact on nurses’ Development. 2006. Available at:
work motivation (14). So, in absence of extrinsic http://www.who.int/hrh/documents/HRH_Afri
rewards (payment, promotion, fringe benefit) ca_JLIreport.pdf. Accessed date: August 29,
which have been found to be the basic sources of 2010.
motivation for nurses, intrinsic reward 2. Hafiza N, Shah S, Jamseheed H, Zamam K.
(recognition) appear to be less important for them. Relationship between rewards and employee
The result of the study also revealed that among motivation in the non-profit organization of
extrinsic rewards, payment is an important tool for Pakistan. Business intelligence Journal. 2011;
their motivation. On the other hand the mean 4(2):327-334.
value of payment compare to other variables 3. Baron, A. Behavior in organization:
revealed that nurses appear to be more de- Understanding and managing the human side
motivated by the payment they are receiving. This of work. New York: Allyn & Bacon Inc,;
finding is consistent with a research done in 1983.
Ghana, where low salaries are the main source of 4. Alemshet Y, Leja H, Alima H, Challi J,
dissatisfaction for health workers (15). The World Morankar S. Job Satisfaction And Its
Bank study also revealed that low salary is main Determinants among Health Workers in
cause for high attrition rate of health workers in Jimma University Specialized Hospital,
Ethiopia public hospitals and health centres (5). Southwest Ethiopia. Ethiop J. health sci. 2010;
In conclusion, the finding of this study 21(special ed.): 19-27
revealed that there is direct and positive 5. The World Bank and Government of Ethiopia.
relationship between rewards and nurses’ work Health Sector Review, Ethiopian Social
motivation. On the other hand, nurses perceived Sector Studies. Addis Ababa: Mega printing
that their organizations are not offering right press, 2004, 1st Ed.
amount of rewards and this has created low-level 6. Al-Ahmadi,H. Factor affecting performance
work motivation for them. The effectiveness of of hospital nurses in Riyadh Region, Saudi
health quality and customer satisfaction is Arabia. International Journal of Health Care
dependent upon the motivation of its employees Quality Assurance, 2009;22(1): 40-54
(16). Therefore, it is recommended that Addis 7. Khan K, Farooq S, Ullah M. The relationship
Ababa Health Bureau together with other between rewards and Employee Motivation in
concerning bodies should revise the current Commercial Bank of Pakistan, Research
reward strategy for nurses. Finally, further journal of international studies, 2010;14: 37-
research could compare between private and 52
public hospitals to see if the type of organization 8. De Beer, M. The impact of reward and
impact the relationship between rewards and recognition programs on employee motivation
nurses’ work motivation. and satisfaction. Bloemfontein: University of
the Free State Press; 1987.
112 Ethiop J Health Sci. Vol. 22, No. 2 July 2012

9. Mitchell, T. Matching motivational strategies 13. Gray, B. Are California Nurses Happy?
with organizational contexts. Journal of Journal of nursing, 1991; 13(2):12-17.
organizational Behavior, 1997; 19(2): 57-63. 14. Chris A, Awobnusi A. Influence of rewards on
10. Rehman, K. A study measuring the effect of workers’ performance in health organization.
pay, promotion and training on job satisfaction Journal of Social Science, 2004; 8(1):7-12.
in the Pakistani service industry. European 15. Agyepong I, Anafi P, Asiamah E, Ansah EK,
Journal of Social Science, 2007; 5(3): 37-51. Ashon DA, Narh-Dometey C. Health worker
11. Roberts, R. Relationship between rewards, (internal customer) satisfaction and
recognition and motivation at insurance motivation in the public sector in Ghana.
company in the Western Cape. Cape Town: International Journal of Health Planning and
University of the Western Cape; 2005. Management, 2004; 19(4):319-336.
12. Cashman S, Parks C, Ash A, Hemingway D, 16. James R. Understanding Employee
Bicknell W. Physician satisfaction in a major Motivation. Journal of Extension, 1998; 36(3).
chain of Investor Owned Walk- in centres. Available at: http://www.joe.org/joe/
Health care management review, 1990;15(2): 1998june/rb3.php. Date accessed: September
47-57. 29, 2010.