Accepted Manuscript

Motivational factors influencing nurses to undertake postgraduate hospital-based

education

Danny Kinsella, Margaret Fry, Alison Zecchin

PII: S1471-5953(17)30128-2
DOI: 10.1016/j.nepr.2018.04.011
Reference: YNEPR 2390

To appear in: Nurse Education in Practice

Received Date: 28 March 2017

Revised Date: 19 February 2018
Accepted Date: 30 April 2018

Please cite this article as: Kinsella, D., Fry, M., Zecchin, A., Motivational factors influencing nurses to
undertake postgraduate hospital-based education, Nurse Education in Practice (2018), doi: 10.1016/
j.nepr.2018.04.011.

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 ACCEPTED MANUSCRIPT

Title: MOTIVATIONAL FACTORS INFLUENCING NURSES TO UNDERTAKE POSTGRADUATE

HOSPITAL-BASED EDUCATION

Authors

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Title Mr.
Author name Danny Kinsella1, RN
1
Affiliation Nursing Education, Alfred Health, Melbourne, Australia

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Phone number +61 3 9076 3227
Address Nursing Education, South Block, Alfred Hospital, 55 Commercial Road,
Melbourne, Victoria, 3004
Email d.kinsella@alfred.org.au

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Title Professor
Author name Margaret Fry 2, 3, PhD

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2
Affiliations Director Research and Practice Development Nursing and
Midwifery Executive Northern Sydney Local Health District
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3
Faculty of Health University of Technology Sydney
PO Box 123, Broadway NSW 2007
Email Margaret.fry@uts.edu.au
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Title Mrs.
Author name Alison Zecchin4, RN, Advanced personnel Management Certificate Acute
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Care Certificate Master of Management

4
Affiliation Director of Nursing and Midwifery Royal North Shore Hospital
Email Alison.Zecchin@health.nsw.gov.au
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Corresponding author
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Title Mr.
Author name Danny Kinsella1, RN
1
Affiliation Nursing Education, Alfred Health, Melbourne, Australia
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Phone number +61 3 9076 3227

Address Nursing Education, South Block, Alfred Hospital, 55 Commercial Road,
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Melbourne, Victoria, 3004

Email d.kinsella@alfred.org.au

Source of Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-
profit sectors
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MOTIVATIONAL FACTORS INFLUENCING NURSES TO UNDERTAKE

POSTGRADUATE HOSPITAL-BASED EDUCATION

ABSTRACT

Specialist postgraduate education improves patient health outcomes, and assists in meeting

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the emerging specialisation of nursing practice. The aim of this study was to investigate the

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motivational factors that influence nurses’ engagement with hospital-based postgraduate

education. The research design was descriptive and exploratory, using a survey method. The

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survey consisted of demographic details, the Participation Reasons Scale (PRS) and open-

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ended questions. Thirty-four participants (100%) completed the survey. Of the PRS extrinsic
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and intrinsic factors, Professional Improvement and Development (Factor 1) and Professional

Service (Factor 2), both intrinsic factors, ranked the highest. Therefore, this study identified
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that intrinsic motivation factors influenced engagement with postgraduate specialty programs

for early career nurses. These results highlight the importance of intrinsic motivation factors
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for a nursing workforce and how this can potentially drive behaviour and decision making. A
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better understanding of motivation factors across a nurse’s career could lead to educational
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strategies that optimise postgraduate program engagement to better support healthcare

delivery and a culture of lifelong learning.

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Highlights
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• Motivation factors can drive nursing education behaviour and decision making

• Motivation factors can promote a learning culture in the nursing workforce

• Intrinsic motivation factors support engagement with hospital-based postgraduate

education

Keywords: Motivation, Education, Learning, Questionnaire, Survey

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MOTIVATIONAL FACTORS INFLUENCING NURSES TO UNDERTAKE
POSTGRADUATE HOSPITAL-BASED EDUCATION

INTRODUCTION

A knowledgeable and competent nursing workforce is instrumental in ensuring safe and

appropriate patient care (Ge et al., 2015, Kennedy et al., 2014a, Clark et al., 2015). To

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develop the necessary nursing knowledge and skills to deliver best practice there is evidence

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to suggest that clinicians need to be motivated to actively engage in learning throughout their

careers (Davis et al., 2014). As such, the provision of effective healthcare services demands a

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workforce that is motivated to learn and strives to ensure the delivery of evidence-based

practice (Chappell and Koithan, 2012, Cook and Artino, 2016, Toode et al., 2015).

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The Institute of Medicine (2010) recommends that nurses become active learners and
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involved in postgraduate education to foster and develop the necessary skills to deliver and

lead healthcare services. As part of this process, nurse educators can play a pivotal role in the
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contemporary nursing workforce by motivating and building a positive learning culture that
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inspires postgraduate learning (Miller, 2016). Lifelong learning refers to a multidimensional

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concept that involves pursuing opportunities for professional development throughout their

career and can include: peer learning, and participation in vocational and postgraduate
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programs (Gouthro, 2017, Jarvis, 2005). Nurse educators can facilitate nurse engagement
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with postgraduate education to meet the ever increasing complexity of patient conditions and

medical technology (Johnson, 2017, Clunie, 2006). In this context, postgraduate hospital-

based specialisation programs are increasing and provide one avenue for learning and

motivation (Lindgren and Lancaster, 2016).

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Across Australia and internationally, models for delivery of postgraduate courses are highly

varied, and include both hospital and university settings (Lahtinen et al., 2014, Dury et al.,

2014, Rautiainen and Vallimies-Patomäki, 2016). Hospital-based programs are focussed on

supporting nurses to initiate the first step in development of practice specialisation capability

and skills. In addition, these programs support the development of critical thinking skills,

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which are associated with achieving optimal patient outcomes.

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There is a significant amount of literature on motivation and nursing education (Miller, 2016)

within the context of undergraduate nursing (Stomberg and Nilsson, 2010) and continual

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professional development (Pool et al., 2016). However, there is less information about
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motivation for postgraduate study, especially with engagement with hospital-based programs.

A deeper understanding of nurses’ motivation for pursuing postgraduate programs may assist
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in building more effective learning environments, targeting educational strategies for

individual learning needs. In addition, understanding motivation may influence how

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educational courses are planned, delivered and evaluated (Joyce and Cowman, 2007, Kubsch
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et al., 2003). Therefore, the aim of this study was to explore and describe what motivational
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factors led nurses to engage with a hospital-based postgraduate specialist program.

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BACKGROUND LITERATURE

Patient Outcomes and Education Level of Nurses

A recent meta-analysis reported that after accounting for nurse-patient ratios and the nurse

practice environment, baccalaureate and higher levels of education in the nursing workforce

leads to improved patient outcomes (Liao et al., 2016). For example, in a US study involving

232,342 surgical patients from 168 hospitals, Aiken et al. (2003) demonstrated that there was

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significant improvement in patient outcomes in hospitals that had a greater proportion of

nurses with baccalaureate or master level education in nursing. Patients experienced lower

mortality and failure-to-rescue rates in hospitals that had a higher proportion of baccalaureate

or master’s educated nurses (odds ratio 0.95, 95% confidence interval, 0.91 – 0.99), and these

results were independent of the known influence of nurse-patient ratios on patient outcomes.

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Similar results were reported in a European study involving 422,730 patients in which both

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nurse-patient ratios and level of nurse education were associated with risk of patient mortality

(Aiken et al., 2014). Estabrooks et al. (2005), in a 10-year study, examined 30-day mortality

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rates for 18,142 patients from 49 hospitals. After adjusting for patient comorbidities and

hospital demographics, nurses with higher education levels demonstrated better patient

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outcomes (log-odds ratio of 0.81 [0.68-0.96]). More specifically, Ge et al (2015) conducted a
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systematic review on the impact of postgraduate-educated nurses in various health
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specialisations, and found that patient outcomes were improved when health care was

delivered by master’s-educated nurses. In addition, Gerrish et al. (2011) conducted a survey

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of 855 advanced practice nurses and reported that nurses who had completed postgraduate
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education were significantly more confident in implementing evidence-based care than those

with undergraduate training only. These findings suggest the added benefit of postgraduate
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training in many areas of nursing practice.

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Motivation and Engagement in Postgraduate Education

In considering the potential benefits of postgraduate training in nursing, it is noticeable that

the uptake of engagement in university-based postgraduate programs remains low (Gilmour

et al., 2017). In the general education literature, both intrinsic and extrinsic motivation factors

have long been considered important to both student engagement and subsequent learning

(Deci et al., 2001). The term ‘motivation’ comes from the Latin word motive meaning ‘to

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move’, and has been defined as the process from which goal directed activities are

undertaken or initiated (Keller, 1979, Cook and Artino, 2016). Research into workplace

motivation typically investigates values, needs, the environment and behavior (Latham and

Ernst, 2006) and considers how these factors impact on employees and a work culture. The

construct of motivation has been postulated to contain intrinsic and extrinsic motivating

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factors (Gagné and Deci, 2005, Cook and Artino, 2016). Intrinsic motivation refers to

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undertaking an activity in response to an inherent interest, value or pleasure associated with

the activity. Extrinsic motivation relates to increasing the likelihood of obtaining external

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benefits such as promotion and or financial gain (Ryan and Deci, 2000).

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Ryan (2003) conducted a study including a range of professional groups (nurses,

occupational therapists and physiotherapists) and examined whether there were different
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motivating factors in pursuing postgraduate education. By interviewing 162 health

professionals, Ryan et al reported no significant differences between professional groups,

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although intrinsic motivation was the predominant driver identified. Similarly, Richards and
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Potgieter (2010), in a South African study, identified that intrinsic factors (e.g. developing
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proficiency, keeping relevant within areas of speciality, and being an effective mentor) were

the strongest motivating drivers for nurses engaging in postgraduate studies. In contrast, an
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Australian longitudinal study (Pelletier et al., 2003) undertaken to explore motivation for
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university-based postgraduate study, surveyed 151 graduating postgraduate nursing students

over 5 years. The researchers identified three motivating factors: personal satisfaction,

professional status, and job opportunities as being the most important motivating drivers for

undertaking postgraduate education. Further, in a UK study of 620 nurses, eight years after

graduation, participants identified that increased job opportunities, intellectual stimulation,

and improvement in clinical judgement were the main motivating factors for participating in

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postgraduate education (Davey and Murrells, 2002a). These studies suggest that both intrinsic

(e.g., increased personal satisfaction) and extrinsic (e.g., increased job opportunities) factors

can motivate participation and engagement with postgraduate education.

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Motivation and Engagement in Hospital-Based Postgraduate Nursing Courses

However, these studies are largely based on retrospective reflections and also relate to

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engagement in university-based postgraduate programs in nursing, involving significant time

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and monetary commitment. Understandably, nurses can be cautious about engaging in these

high commitment programs, with ‘barriers’ identified including; financial, geographical

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location, family commitments, and refusal of support from employer (Lahtinen et al., 2014,
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Hegney et al., 2010, Coventry et al., 2015). Therefore, in many countries, an alternative path

in postgraduate training has been developed through provision of hospital-based postgraduate

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courses that focus on skill development for a range of practice specialisations (Ng et al.,
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2016, Dury et al., 2014). These skill-based courses are often supported by the employing
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health care organisation in terms of rostered study leave and course costs, thereby providing a

supported entry into postgraduate study. To date, there is an absence of literature about the
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motivations of nurses for undertaking these courses (Altmann, 2012). This is important to

address as the motivation of the nurse who embarks on these postgraduate hospital-based
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courses may differ considerably from the more theoretically-oriented university degrees. An
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understanding of motivating factors (intrinsic and extrinsic) for nurses’ engagement in

hospital-based postgraduate courses will contribute to course content development, and

potentially contribute to enhancing engagement in the pathway to further postgraduate

education (Kovner et al., 2012).

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RESEARCH DESIGN

Research design

This is a descriptive exploratory study which used a survey method to investigate the

motivational factors influencing the participation of a cohort of nurses into a hospital-based

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postgraduate-based course.

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Site

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The multisite study was based on a local health district located in metropolitan Sydney,

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Australia. The health district covers over 900 square kilometers with a population catchment
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of 853,000 people. It includes six public hospitals, of which one is a Level 6 tertiary referral

hospital and five are Level 5 district hospitals. A Level 6 tertiary referral hospital provides
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acute and critical care services 24 hours a day, seven days a week. Level 5 district hospitals

have limited surgical and intensive care services (Commonwealth of Australia, 2013).
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Sample
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All nurses who enrolled in the annual health district’s specialist postgraduate program
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entitled Continuing Appraisal Program (or CAP) were invited to participate in the study.
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The CAP program, incorporating sub-streams for several specialisations, is a 10-month

postgraduate education program and affiliated with a local university. Following completion

of the CAP program, participants have the opportunity to enter into further university-based

academic postgraduate programs. The CAP program, which is voluntary for clinicians, is

designed to facilitate both the capacity and skill development of registered nurses into the

specialist nurse role. The CAP program specialties include: Acute Care, Critical Care,

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Perioperative, Community, Post-Acute Care, Neurosciences, Gerontology and Rehabilitation,

and Anesthetic/Recovery nursing. This hospital-based postgraduate course is conducted on a

hospital campus, coordinated by hospital-employed nurse educators, and is conducted

through sub-specialisation modules. Professional development leave is available to each

participant and the course is funded by the health service. Study inclusion criteria were: (i)

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professional registration as a nurse; and (ii) attendance at the orientation day of the

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postgraduate course. All potential CAP participants attending the orientation day were

provided with a study information sheet and the survey by the researcher. The survey was

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anonymous and could be returned to a locked box located in the teaching area or returned via

mail.

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Questionnaire
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The 36-item questionnaire consisted of participant demographic items, the Participation

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Reasons Scale (Grotelueschen, 1985) survey and two open ended questions. The
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demographic items included: age, gender, years of nursing experience, years of specialty

nursing experience, highest achieved level of education, and current hospital employment.
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The 30-item Participation Reasons Scale (PRS) survey was designed to assess motivational

factors for postgraduate students (Grotelueschen, 1985). The PRS ranks items using a 7-point
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likert scale, with 1 being ‘not important’ and 7 being ‘extremely important’. The PRS has
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been used with a range of professional groups including: the military (Grzyb, 1997),

cytotechnologists (Balachandran and Branch, 1997), nuclear power technicians (McCamey,

2003), solicitors (Hill et al., 2004), medical physicians (Cervero, 1981) and nurses (Aucoin,

1998, DeSilets, 1995b, Flores Peña and Alonso Castillo, 2006). The PRS has been tested for

reliability using Cronbach alpha with measures between 0.78 to 0.92 (Grotelueschen, 1985).

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The 30-item PRS items has been grouped into five motivational factors, which reflect

intrinsic and extrinsic motivators (DeSilets, 1995a). Factor 1 – Professional Development &

Improvement groups nine questions reflecting intrinsic motivators; Factor 2 – Professional

Service groups five questions, reflecting intrinsic motivators; Factor 3 – Learning &

Interaction with Colleagues groups four questions, reflecting extrinsic motivators; Factor 4 –

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Personal Benefits & Occupational Safety groups six questions, reflecting extrinsic

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motivators; and, Factor 5 – Professional Commitment & Reflection groups six questions

reflecting intrinsic motivators.

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Statistical Analysis
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Data was analysed using IBM SPSS v.22 (Corp., 2013). Descriptive statistics were calculated

to characterise the sample. The mean scores for individual PRS items were rank ordered. PRS
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items scores greater than 6 were considered of high importance and items scoring less than 4
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were considered of low importance (DeSilets, 1995b, Aucoin, 1998). A one way between
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subjects analysis of variance (ANOVA) was conducted to compare the effect of Factors on

motivation to engage with postgraduate specialist programs. Given the small sample, a
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Bartlett’s test of sphericity was undertaken, requiring significance at p < 0.05 (Tabachnick

and Fidell, 2013). Qualitative data were analysed, organised thematically, and stored and
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managed using NVivo 10 software (QSR International, 2014). Qualitative data was analysed
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thematically using analysis was supported by Gibbs’s (2007) framework, which requires the

researcher to transcribe and become familiar with data; develop analytical data codes; analyse

for dis/confirmatory themes; and consolidation of data interpretation. The authors discussed

and reviewed the coding and the emerging themes.

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Ethics

This study received ethical approval by the Human Research Ethics Committee

(LNR\13\HAKE\426) of the participating health service. All electronic survey data were

stored in password protected files with paper copies stored in a locked filing cabinet in the

office of the co-investigator.

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RESULTS

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Sample Characteristics

Thirty-four nurses participated in the CAP program (n = 34; 100%) and all agreed to

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participate in the study. The majority of participants (n = 27; 79.4%) were female. All
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participants had completed a baccalaureate degree (Table 1). The mean age of participants
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was 30 years (SD 9.5), and the mean years of nursing experience was 4 years (SD 5.8). The

majority of participants (n = 21; 62%) were employed in district hospitals (Level 5) and had
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enrolled in the Acute Care (n = 12; 35%) or Critical Care (n = 8; 23%) sub-specialty modules
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of the program.
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Responses to the Participation Reasons Scale

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Frequency of responses to individual PRS questions are provided in Table 2. It was noted that
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only 10 questions (33.3%) had a mean score of 6 or more, associated with a high

endorsement as a motivator for engaging in the course. Of the 10 highest ranked questions (1,

3, 4, 9, 14, 18, 20, 21, 27 and 29), only Question 20 characterises extrinsic motivation. Of the

five factors, Professional Improvement and Development (Factor 1) and Professional Service

(Factor 2) ranked the highest with mean scores 6.24 and 6.37 respectively (Table 2). Both

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Factor 1 and 2 relate to intrinsic motivational themes. Factor 4 Personal Benefit and Job

Security (mean factor score 5.43) was the least motivating factor driving postgraduate

education participation. Factor 4 reflects an extrinsic motivating factor.

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Using one-way ANOVAs of participant responses for each factor, it was found that Factor 1

(p = 0.01), Factor 2 (p = 0.03), and Factor 5 (p = 0.003) had an effect on driving nurses’

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engagement with postgraduate education programs (Table 3). Analysis demonstrated that

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48% of variance was due to Factor 1 (intrinsic motivation).

Responses to the open-ended questions

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Of the 34 participants, 17 (50%) provided responses to the open-ended questions – (i)“Do
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you believe that motivation is important for enrolling in the course?”, and (ii) “Please

provide insight for your perspective”. The majority of these participants reported that
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intrinsic motivators were more important than extrinsic motivation factors when deciding to
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undertake postgraduate nursing programs. To illustrate:

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“I want to improve my knowledge and practice to improve patient quality care”

(participant 4).
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“Improving my abilities is important for me to give better patient care”

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(participant 2).

“… my motivation to improve my skills and knowledge comes from my motivation to

improve how I care for my patients” (participant 7).

Only one participant (5.8%) reported that extrinsic motivation was the driver behind pursuing

postgraduate education;

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“… competencies through the program will benefit me a lot, move me forward to

work on being a CNS [Clinical Nurse Specialist]” (participant 9).

Many participants reported that motivation also supports resilience when undertaking

postgraduate nursing programs. For example.

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“Motivation is what keeps me going through the struggles and difficulties of

anything I do” (participant 8).

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“Motivation is necessary to complete the course” (participant 20).

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Motivation was identified as key to managing personal, clinical and professional challenges:

The following response illustrates.

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“It [motivation] pushes the boundaries and you can give more” (participant 18).
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However, some respondents reported that other clinical staff can mediate and be a catalyst for
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personal motivation. In particular, staff in leadership roles, such as managers and educators,

can activate motivation factors when providing encouragement to pursue postgraduate

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programs: one participant discussed.

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“Motivation to complete the postgraduate program can come from managers who
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encourage staff to personally and professionally develop” (participant 12).

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DISCUSSION

The study identified the motivational factors of nurses undertaking a hospital-based

postgraduate course. While previous research has suggested, mainly through retrospective

observations, that nurses undertaking university-based postgraduate education are motivated

by both extrinsic and intrinsic factors (Aucoin, 1998, DeSilets, 1995b), there is a lack of

information relating to hospital-based programs. This gap needs addressing as hospital-based

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courses can serve as the initial step in a nurse’s commitment to ongoing postgraduate

education. Using a convenience sample, we found that nurses predominantly endorsed

internal motivating factors as reasons for enrolling in the course. The most highly ranked

factors were Professional Improvement and Development, Professional Service, and,

Professional Commitment. The common themes linking these factors are a commitment to

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maintain the quality of their nursing practice and to increase proficiency in high-quality

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patient care.

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The impact for nurse educators developing hospital-based courses is that the teaching of

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advanced nursing knowledge and closing the practice-theory practice gap needs to be linked
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to practical application and patient outcomes. This will more likely result in ongoing

engagement of nurses in future postgraduate education by linking teaching models to student

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motivation and needs (Miller et al., 2017). Nevertheless, it is also recognised that certain

individual characteristics of nurses may moderate motivations for further education (Kyndt et
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al., 2016). Given the high number of females in the study sample (79%), further research is
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needed to explore whether these findings may reflect gender bias, the culture of the nursing
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profession, level of education, and, or define personality traits of staff employed as nurses

(Kennedy et al., 2014a, Orsini and Binnie, 2016, Kennedy et al., 2014b).
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Extrinsic motivation factors, such as personal benefits and job security, were not as strongly

endorsed in driving decision-making to participate in postgraduate programs. The least

endorsed individual questionnaire items included ‘to enhance the security of my present work

position’ (Q. 28), and ‘to increase the likelihood of personal financial gain’ (Q. 11). These

findings need to be considered in the context of the early career status of the cohort (the mean

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years of nursing experience = 4 years), as it has been suggested that extrinsic factors, such as

increased job opportunities, are associated with undertaking university-based postgraduate

training (Sarver et al., 2015). Interestingly, the study findings suggest that early career nurses

are less motivated to pursue ongoing education by concerns of job security or financial gain.

Instead, participants’ prime motivations were perceived as personally important and had

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intrinsic value to nursing. This suggests that early-career motivations are embedded within

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beliefs and values.

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Expanding on this research is important as motivation may play an important role in

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workforce recruitment, retention and expertise. Indeed, understanding motivation for early
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career nurses may better ensure a lifelong learning approach is sustained. There are a number

of theories which have sought to explain the motivation to learn, including expectancy values
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and attribution, and social cognition models for goal orientation and self-determination (Cook

and Artino, 2016, Orsini and Binnie, 2016). Motivation is determined by the process of goal
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directed activities. Self-determination theory argues that to optimise performance, individuals

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need to internalise intrinsic or extrinsic motivation values and understand how they drive
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behaviour. It is unclear if throughout a nurse’s career the dominance of intrinsic or extrinsic

motivation factors change over time and so further research is needed to explore the dynamic
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praxis between the internalising of motivation and a learning workforce. Further,

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consideration of what drives learning in a profession, such as nursing, is critical to ensuring

capacity and skill to better manage the complex and challenging environment of healthcare.

Therefore, organisations and nurse educators, seeking to optimise workforce performance,

need to articulate and clarify the value of postgraduate programs to personal growth.

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Motivation is important to improve the quality of practice and patient outcomes. For the

individual clinician, motivation is critically import to engage a desire to improve

professionally. In this study, the desire to improve personal knowledge and skills with

specialty streams was perceived to enhance practice activities, quality and safety. However,

motivation factors clearly operate differently depending on the activity being pursued. While

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in this study three factors were reported to facilitate engagement in education this may differ

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within different educational contexts. Further research is needed to explore the different

factors across different educational contexts; for example, with mandatory education (Ross et

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al., 2013).

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The study identified the importance of intrinsic motivation factors for postgraduate education

involvement. Supporting the quantitative data, thematic analysis highlighted that motivation
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was necessary to pursue their postgraduate education. Educational organisations, health care

services and nurse educators need to consider the importance of cultural context and
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embedded beliefs and values within a ward, unit or service as this may directly influence the
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expectancy of staff to undertake educational activities (Kyndt et al., 2016). This has wide
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implications for supporting and driving expectancy around lifelong learning and

interprofessional communication and collaboration, which are fundamental to quality safe

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healthcare.
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Motivation is essential for encouraging professional development across all healthcare

disciplines. Further, the World Health Organisation (2013) has identified that education

providers (hospitals and universities) need to facilitate education which meets the needs of an

ever increasing specialised healthcare workforce. Flexible educational pathways are needed

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that support the advancement of the clinician’s knowledge, skills and capabilities to practice.

Hospital-based programs can provide one strategy to meet the growing demand for specialist

knowledge.

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Motivation is important to patient safety, advancing science and resilience for managing

change (Tjin et al., 2016, Lestari et al., 2016). This study identified the importance of

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intrinsic motivational factors. Studies have found that autonomously-driven intrinsic

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motivation will result in more positive educational outcomes (Orsini and Binnie, 2016).

Identification of further measures to explore associations between lifelong learning and

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intrinsic motivation could better support learning and a culture of evidence based practice.
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Educators development of the educational environment may better support how nurses

approach learning activities and ongoing education (Orsini and Binnie, 2016).
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This study identified that the most important ranked motivation recorded by participants for
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engaging in postgraduate education was to ‘help me to become more competent in my current

workplace’, better accommodate the ‘needs of the patient’, and followed by ‘increase the
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likelihood of patients receiving better management’. These statements address intrinsic

motivating factors as the most self-determined form of behaviour. By understanding the

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determinants and outcomes of motivation, educators can plan and/or implement strategies
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that may stimulate nurse engagement with educational opportunities. This was highlighted

within the qualitative data where managers and educators were named as playing a key role

in motivation. Studies have identified that motivation factors often correlate with career

progression and role demands of nurses (Amabile, 1993). More specifically, early career

nurses have been shown to have a desire to extend knowledge and clinical skills, to enhance

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patient outcomes (Gijbels et al., 2010). This study sample of early career nurses ranked

intrinsic motivation factors more highly than extrinsic factors. In contrast, experienced or

tenured nurses have expressed extrinsic motivation factors, such as developing their career

trajectories, as more important (Toode et al., 2015, Davey and Murrells, 2002b). The reasons

and extent of this shift in perspective needs further investigation in future cohorts of nurses

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over their careers.

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Creating a learning environment that supports and activates motivation factors are more

likely to result in positive cognitive, affective and behavioural outcomes (Orsini and Binnie,

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2016). Further, there is evidence that intrinsically motivated staff, engaged in educational
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activities, will also deliver more person-centered care that is supportive and collaborative

(Orsini and Binnie, 2016). Clearly, nurse educators need to be mindful that motivating
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factors may differ across the workforce career trajectory and individual consideration will be

needed to encourage participation in postgraduate programs.

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Limitations
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There are a number of limitations that need to be considered when interpreting the findings of
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this study. Firstly, the participants within this study were drawn from one multi-campus
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health district, potentially limiting generalisability. However, a diversity of specialties and a

variety of hospitals were represented in the study. The sample was small and as such further

appropriately powered studies need to be conducted to explore causal relationships.

Furthermore, while the findings identify motivation factors for engaging in postgraduate

education it is unclear whether they impact on course completion and future course

enrollment. The findings of this study may not be relevant to understanding the motivational

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factors for nurses engaging with mandatory education, research-based university

postgraduate, or baccalaureate education programs. While the study used survey methods,

further research using a qualitative approach may provide a deeper understanding of

motivation factors and how they drive behaviour throughout a nurse’s career.

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CONCLUSION

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This study demonstrated that intrinsic motivation factors drove engagement with hospital-

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based postgraduate specialty programs for early career nurses. Intrinsic motivation factors

created the expectancy for these nurses to develop their knowledge and skills to improve

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patient care delivery. An intrinsically motivated workforce that values and is interested in
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learning is more likely to engage in ongoing educational activities and deliver more person-

centered care. These results highlight the importance of intrinsic motivation factors for a
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nursing workforce and how this can potentially drive behaviour and decision making. A
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better understanding of motivation factors across the nursing career trajectory could lead to
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embedded strategies within education programs and optimise marketing to better support

health organisations to facilitate a culture of lifelong learning and engagement with

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postgraduate education.
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Table 1. Demographic of Participants (N = 34)

n (%)
Gender
Female 27 (79.41)
Male 7 (20.59)

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Age
Mean years (SD) 30 (9.49)

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Nursing Experience
Mean (SD) 4.39 (5.79)

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Hospital Level
Level 5 21 (61.76)
Level 6 13 (38.24)
Specialisations
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Acute Care 12 (35.29)
Critical Care 8 (23.52)
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Perioperative 4 (11.76)
Community and Post- Acute Care 3 (8.82)
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Neurosciences 3 (8.82)
Gerontology and Rehabilitation 2 (5.88)
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Anaesthetic/Recovery 1 (2.94)
Missing 1 (2.94)
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Highest level of education achieved

Undergraduate Bachelor Degree 30 (88.23)
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Graduate Certificate 3 (8.82)

Master Degree 1 (2.94)
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Table 2. Participant Responses for Each Item of the Participation Reason Scale (N = 34)

Question Mean Standard

Deviation

Factor 1: Professional Improvement and Development * 6.24 0.94

Develop my knowledge and skills for future health care needs of the
community 1 6.26 0.86
To help me be more productive in my professional role 3 6.55 0.37
To maintain my current abilities 5 5.97 0.93

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To develop new professional role or practice 16 4.64 2.29
To develop my prospective of my professional role or practice 17 5.75 1.50
To keep abreast of new developments in my specialisation 18 6.05 1.75

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To helped me to be more competent in my current workplace 21 6.64 0.41
To develop proficiencies necessary to maintain quality performance 27 6.32 0.95
To maintain the quality of my professional service 29 6.23 0.91

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Factor 2: Professional Service* 6.37 1.06
To enable me to better meet patient expectations 4 6.32 1.25
To better accommodate the needs of patients 9 6.58 0.49

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To increase my proficiency with patients 14 6.50 0.62
To help me increase the likelihood patients receive better management 19 6.55 0.73
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To improve my professional service to community 25 5.88 2.28

Factor 3: Collegial Learning and Interaction** 5.50 1.25

To help me be more productive in my professional role 2 5.35 1.62
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To relate my ideas to those of professional peers 7 5.75 1.50

To learn from other nurses enrolled in CAP 12 5.50 1.53
To be challenged by the thinking of my colleagues 23 5.38 1.57
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Factor 4: Personal Benefits and Job Security** 5.34 1.44

To increase the likelihood of benefitting my family and friends 6 5.35 1.62
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To increase the likelihood of personal financial gain 11 4.76 2.42

To obtain leadership capabilities 13 5.82 1.84
To assist changing my present professional role 15 5.79 1.25
To increase the likelihood to advance my present work position 22 5.35 1.75
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To enhanced the security of my present work position 28 4.91 1.40

Factor 5: Professional Commitment and Reflection** 5.72 1.33

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To maintain my identity with my speciality of nursing 8 6.05 1.75

To redevelop my commitment to my speciality of nursing 10 5.97 2.02
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To assess the direction in which my profession is going 20 6.00 1.63

To enhance the image of my profession 24 5.35 1.75
To considered the limitation of my professional role 26 5.02 1.48
To reflect on the value of my professional responsibilities 30 5.88 1.44

* internal motivating factor ** external motivating factor

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Table 3. One-Way Analysis of Variance of Participant Responses for Each Factor

Factors df SS MS F F crit. P

Factor 1: Professional Improvement and Development

Between groups 8 17.30 2.16 2.55 1.97 0.01
Within groups 297 252.15 0.85
Total 305 269.44

Factor 2: Professional Service

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Between groups 4 11.56 2.89 2.67 2.42 0.03
Within groups 165 178.08 1.07
Total 169 189.65

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Factor 3: Collegial Learning and Interaction
Between groups 3 3.39 1.13 0.72 2.67 0.53
Within groups 131 204.35 1.55

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Total 134 207.74

Factor 4: Personal Benefits and Job Security

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Between groups 5 62.20 12.44 6.87 2.25 6.08
Within groups 198 358.08 1.80
Total 203 420.28
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Factor 5: Professional Commitment and Reflection
Between groups 5 30.39 6.078 3.61 2.25 0.003
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Within groups 198 333.11 1.68

Total 203 363.50
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