Generational differences can also account for variability in worker motivation (Atkinson,

2003; Billings & Kowalski, 2004; Cordeniz, 2002; Hill, 2004; Izzo & Klein, 1998). Baby
Boomers are interested, for the most part, in job security. If an employee from this generation
knows that performance will lead to long-term employment, the employee will work to
maintain that employment. Unfortunately, recent layoffs at major corporations, including
health-care corporations, have challenged the notion that good performance leads to job
security. Baby Boomers, born largely between the post–World War II era and 1964, grew up
in era in which they learned to challenge those in power and authority (Cordeniz, 2002).
Thus, Baby Boomers often question what others tell them to do and want to know the reasons
why decisions have been made. Rules are not motivators for behavior for Baby Boomers.
Generation X’ers, born between 1965 and about 1977, grew up in an era when technology
became paramount. This group works primarily for personal satisfaction and growth
(Cordeniz, 2002). Balancing work and personal life is an important goal for this group.
Whereas their parents valued organizational loyalty, members of this group change jobs when
the work environment no longer challenges or satisfies them (Cordeniz, 2002; Hill, 2004).
Money is more of a motivator for this group than for earlier generations. The Net Generation
is just now coming into the workforce. These workers were born in the 1980s. In
McClelland’s terms, these workers are motivated by affiliation. They prefer to work in
groups and teams and are hands-on learners (Billings & Kowalski, 2004). Unlike earlier
generations, they grew up in a very diverse society (Hill, 2004). The Net Generation is more
motivated and satisfied when working within diverse group settings. This group is also most
comfortable with technology; cell phones and e-mail have always existed for them. Exposed
to a wide array of technology, the Net Generation is motivated by settings where the
technology is advanced and current. Motivation can be complex, and it differs by the
individual. In order to maximize organizational effectiveness, the task for leaders and
managers is to discover what motivates individual workers and to create a work environment
that capitalizes on these motivations.

Motivation Yields Job Satisfaction Yields More Successful Organizations Job satisfaction
occurs when a nurse’s motivational needs are met. Nurses and other employees work in order
to have certain needs met, such as finan-cial and growth needs. When those needs are met,
employees express satisfaction with their jobs. This crucial link between motivation and job
satisfaction has far-reaching consequences for an organization. In short, if nurses and other
health-care employees are satisfied, personnel turnover decreases, the quality of patient care
increases, and the organization’s financial outlook improves. JOB SATISFACTION FOR
NURSES What leads to job satisfaction for nurses and other health-care workers? Herzberg
(2003) and Timmreck (2001) suggest that money is not the primary motivation for job
satisfaction for nurses. Of course, nurses and others need to make a decent living, but other
factors masy play a more important role in job satisfaction. McNeese-Smith (1999) found that
while nurses did derive some satisfaction from salary, benefits, and the ability to balance
work and family life, the most satisfying part of the job was patient care itself. Factors that
inhibited job satisfaction were those that hindered the ability to accomplish patient care,
including lack of supplies, feeling overloaded, and difficulties in communicating with
physicians. Relationships with coworkers could cause satisfaction or dissatisfaction as well.
Control over work environment and autonomy in decision making also contribute to job
satisfaction (Freeman & O’Brien-Pallas, 1998). Allowing nurses to decide how patient care is
to be delivered and the opportunity to use their skills promotes a satisfying work climate.
Hackman and Oldham’s (1980) Job Characteristics Model of Work hypothesizes that the
combination of core job dimensions, such as skill variety, task identity, task significance,
autonomy, feedback on job performance, perceived meaningfulness of work, and knowledge
of and responsibility for outcomes, leads to job satisfaction. Edgar (1999) used this model to
confirm that autonomy, meaningful work, and opportunity to use a variety of skills promote
job satisfaction for nurses who work in hospitals. Autonomy and work enrichment are also
important for nurses who work in community-based settings. Laamanen, Broms, Happola,
and Brommels (1999) found that work motivation and job satisfaction did increase when
home health nurses had autonomy and variability in tasks. They became dissatisfied when the
workload became unmanageable. Likewise, school nurses have ranked autonomy as the most
important job satisfier (Foley, et al., 2004). School nurses ranked the other following factors
as important to job satisfaction: interaction with coworkers, professional status, pay,
organizational policies, and task requirements. A study of hospice nurses also revealed that
autonomy was positively linked to job satisfaction, as was positive supervisory support
(DeLoach, 2003).

ORGANIZATIONAL AND PATIENT OUTCOMES Knowing what promotes job

satisfaction for nurses is significant because the level of job satisfaction has been connected
to patient outcomes (Scott, Sochalski, & Aiken, 1999). In a series of studies of magnet
hospitals, Aiken and her colleagues discovered a clear link between organizational
characteristics, including nurse job satisfaction, and patient outcomes. According to Scott et
al., magnet hospitals are characterized by lower nurse turnover, more nursing autonomy and
control over practice, and better nursing relationships with physicians. Scott et al. noted that
magnet hospitals also have lower patient mortality and higher patient satisfaction. More
recently, Aiken, et al., (2002) reported that organizational characteristics such as high patient
to nurse ratios contributed to nurse burnout, job dissatisfaction, and higher patient morbidity
and mortality rates. Aiken and colleagues’ work demonstrates that attending to job
satisfaction is a necessity in order to achieve positive patient outcomes. On an international
scale, Tzeng and Ketefian (2002) demonstrated in an exploratory study conducted in Taiwan
that nurse job satisfaction was related in part to some measure of patient satisfaction, such as
satisfaction with pain management and arrangement for follow-up care post-discharge. This
study confirms that nurse satisfaction does influence customer satisfaction, which is critical
because if customers are not satisfied with care they receive, they will go elsewhere, and that
health-care organization will suffer financially. Nurse satisfaction also affects the bottom line
of health-care organizations. If nurses become dissatisfied and subsequently leave their jobs,
the organizations suffer. According to Atencio, Cohen, and Gorenberg (2003), the cost of
turnover is up to two times the nurse’s salary. For example, if the average nurse’s salary in an
organization is $46,000 and 10 nurses leave in a year’s time, the cost to the organization is
close to a million dollars. As Herzberg’s theory suggests, nurses will leave organizations if
the dissatisfiers outweigh the motivators (Herzberg, 1966). Davidson, Folcarelli, Crawford,
Duprat, and Clifford (1997) report that intent to leave was predicted by poor communication
within the organization and heavy workload (Hinshaw & Atwood, 1983; Pearlin & Schooler,
1978; Price & Mueller, 1981). Additionally, Cline, Reilly, and Moore (2003) confirm that
nurses will leave when management is nonsupportive, the pay is unsatisfactory, and staffing
ratios are poor. They point out that nurses will tolerate understaffed and perceptually unsafe
settings for only a limited amount of time. If nurses cannot get their concerns addressed, they
will leave the organization.

Leadership Makes a Difference One of the critical determinants of job satisfaction for nurses
is relationships with supervisors. Being able to communicate effectively with supervisors can,
in and of itself, serve as a motivating factor for nurses. Early on, McGregor (1960) described
the relationship between leadership style and worker motivation. According to McGregor, a
Theory X management style presupposes that humans inherently dislike work, do not want to
be accountable and responsible for their actions, and need to be prodded to do work.
Managers who espouse Theory X use such strategies as rewards, threats, and punishment to
get workers to do their jobs. A Theory Y leadership style, on the other hand, assumes that
workers can achieve their personal goals by integrating their goals with those of the
organization. The Theory Y manager’s job, then, is to foster this integration by using a
variety of human relations approaches. For example, a nurse who wants to work for a
master’s degree in nursing may choose an organization that promotes educational mobility.
The nurse’s supervisor might work with the nurse to develop a schedule that will facilitate
this goal. A manager who espouses the Theory Y approach is more likely to attract
employees than a Theory X manager who rules with an iron fist. One particular human
relations approach was tested in research conducted by Mayfield, Mayfield, and Kopf (1998).
They demonstrated that if a leader used motivating language in giving direction and sharing
feelings, nurses expressed a higher level of job satisfaction and job performance. One such
example of motivating communication could be telling a nurse in front of peers that he did a
good job with a particular patient. They caution, however, that communication is not enough
to sustain 34 Understanding the Theory of Leading, Following, and Managing 03Jones
Leadership(F)-ch 03 1/14/07 4:07 PM Page 34 job satisfaction. Rather, communication plus
organizational behavior, such as providing meaningful rewards, help to improve employee
performance and job satisfaction. Leadership style can also be characterized by whether
leaders are transformational or transactional. Transformational leaders direct by role
modeling, promoting employee development, providing a stimulating work environment, and
inspiring optimism. Transactional leaders lead by being taskfocused, focusing on the daily
work of the organization, setting employee goals for them, and focusing on the reward system
(Marriner-Tomey, 2004). Morrison, Jones, and Fuller (1997) found that job satisfaction was
higher when leaders were perceived as both transformational and transactional but that the
relationship between nurses and transformational-style managers was stronger. Only
transformational leadership was positively related to empowerment (intrinsic task
motivation). An interesting finding was that the relationship between job satisfaction and
transformational leadership style was more powerful for unlicensed personnel. These findings
may suggest that different categories of employees are motivated by different leadership
styles. Leaders who maintain a positive work environment also have more success in keeping
employees satisfied. Spence-Laschinger, Finegan, and Shamian (2001) suggest that work
environments that empower nurses to use their expert decision making promote trust within
the organization and lead to job satisfaction. Nurse leaders/managers are crucial in promoting
trusting work environments. Aside from staff nurse perceptions of the importance of
leadership, nurse leaders, by their own admission, know that being accessible and fostering a
professional practice environment that promotes teamwork are crucial to nurse job
satisfaction (Upenieks, 2003). Like Frank, Eckrick, and Rohr (1997), Upenieks also noted
that leaders play a critical role in obtaining resources for the delivery of optimal patient care,
which in turn promotes job satisfaction. If leaders fail to promote teamwork and acquire the
needed resources for quality patient care, job satisfaction and quality of patient care decrease.
All Good Things… In this chapter, we have explored ways that nurse leaders/managers can
motivate employees to deliver high-quality care. Motivating employees, while not a simple
task, has significant payoffs both for the employees and the organization as a whole. A
variety of theories can be used by leaders/managers to guide them in promoting a climate that
fosters job satisfaction and subsequent quality patient care. Leaders/managers need to be
cognizant of the fact that what motivates one employee may not motivate another. Therefore,
they may need to use a variety of motivational strategies in order to achieve positive patient
and organizational outcomes.