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 DIRECTING

Management is the art of getting things done through others. One of the main functions of a
manager is to direct subordinates effectively. Directing is concerned with carrying out the
desired plans. It initiates organized and planned action and ensures effective performance by
subordinates towards the accomplishment of group activities.

Direction is called management in action. In the words of Theo Haimann, “In order to make
any managerial decision really meaningful, it is necessary to convert it into effective action,
which the manager accomplishes by directing. Without this managerial function nothing or at
best very little is likely to come about.

DIRECTING is said to be a process in which the managers instruct, guide and oversee the
performance of the workers to achieve predetermined goals. Directing is said to be the heart
of management process. Planning, organizing, staffing have got no importance if direction
function does not take place.

Directing initiates action and it is from here actual work starts. Direction is said to be
consisting of human factors. In simple words, it can be described as providing guidance to
workers is doing work. In field of management, direction is said to be all those activities
which are designed to encourage the subordinates to work effectively and efficiently.
According to Human, “Directing consists of process or technique by which instruction can be
issued and operations can be carried out as originally planned” Therefore, Directing is the
function of guiding, inspiring, overseeing and instructing people towards accomplishment of
organizational goals.

Planning, organizing and staffing can be considered preparatory managerial functions the
purpose of controlling is to find out whether or not the goals are being achieved. The
connecting and actuating link between these functions is the managerial function of directing,
which means the issuance of directives and the guidance and overseeing of subordinates.”

“Just as starting the motor of a car does not make it move unless put into gear and the
accelerator pressed, in the same way organized actions are initiated in the enterprise only
through the directing function of management.
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In order to clearly understand the meaning of directing function of management, a few

definitions are given as follows:
Definitions:
“Directing concerns the total manner in which a manager influences the action of
subordinates. It is the final action of manager in getting others to act after all preparations
have been completed.” Massie

“Directing is the interpersonal aspect of managing by which subordinates are led to

understand and contribute effectively and efficiently to the attainment of enterprise’s
objectives.” Koontz and O’Donnel

“Directing is the guidance, the inspiration, the leadership of those men and women that
constitute the real core of the responsibilities of management.”

“Telling people what to do and seeing that they do it to the best of their ability. It includes
making assignment, explaining procedures, seeing that mistakes are corrected, providing on
the job instruction, and of course, issuing order.” Urwick and Breach

“The heart of administration is the directing function which involves determining the course,
giving order and instructions, providing the dynamic leadership.” Earnest Dale

“Directing consists of the process and techniques utilizing in issuing instructions and making
certain that operations are carried out as originally planned.” Marshall E. Dimock

Haimann remarks from the above definitions, we can conclude that the directing function of
management is the heart of management process as it is concerned with initiating action. It
consists of all those activities which are concerned with influencing, guiding or supervising
the subordinates in their job.

 BASIC CONCEPTS ABOUT DIRECTING

 Direction consists of the process and techniques utilizing in issuing instruction and
making certain that operations are carried out as originally planned.
 Direction is a complex function that includes all those activities which are designed
to which encourage subordinates to work effectively and efficiently in both short
and long run.
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 Direction is telling people what to do and seeing that they do it to the best of their
ability.
 Directing deals with the steps a manager takes to get subordinates and others to
carry out plans.
 Direction provides link between different functions in an organization.

The Three important skills that the nurse manager must possess when they
are trying to influence the behaviour of other:-

1) Diagnose: The manager must first know the problem or the situation that needs
direction.
2) Adapt: - As the situation demands, the manager must try to fit themselves into the
situation & understand it before directing others to do so.
3) Communication:- Having understood , analysised & changed their behaviour according
to the situation the managers shall communicate to other members to understand the
situation & change their behaviour accordingly.

 NATURE OR CHARACTERISTICS OF DIRECTION:

The following features of direction bring out the nature of directing function of
management:
1. It is a Dynamic Function:
Directing is a dynamic and continuing function. A manager has to continuously direct, guide,
motivate and lead his subordinates. With change in plans and organizational relationships, he
will have to change the methods and techniques to direction.

2. It Initiates Action:
Directing initiates organized and planned action and ensures effective performance by
subordinates towards the accomplishment of group activities. It is regarded as the essence of
management-in-action.

3. It Provides Necessary Link between Various Managerial Functions:

Directing links the various managerial functions of planning, organizing, staffing and
controlling. Without directing the function of controlling will never arise and the other
preparatory functions of management will become meaningless. In the words of Haimann,
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“nothing happens unless and until the business automobile is put into gear and the accelerator
pressed.”

4. It is a Universal Function:
Directing is a universal function that is performed in all organizations and at all the levels of
management. All managers have to guide, motivate, lead, supervise and communicate with
their subordinates, although more time is spent on directing at higher levels of management.

5. It is Concerned with Human Relationships:

The direction function of management deals with relationship between people working in an
organization. It creates cooperation and harmony among the members of the group. It seeks
to achieve orderly arrangement of group effort to provide unity of action in the pursuit of
common objectives.

 PRINCIPLES OF EFFECTIVE DIRECTION:

Effective direction leads to greater contribution of subordinates to organization goals. The
directing function of management can be effective only when certain well accepted principles
are followed.

The following are the basic principles of effective direction:

1. Harmony of Objectives:
It is an essential function of management to make the people realize the objectives of the
group and direct their efforts towards the achievement of their objectives. The interest of the
group must always prevail over individual interest. The principle implies harmony of
personal interest and common interest. Effective direction fosters the sense of belongingness
among all subordinates in such a way that they always identify themselves with the enterprise
and tune their goals with those of the enterprise.

2. Unity of Command:
This principle states that one person should receive orders from only one superior, in other
words, one person should be accountable to only one boss. If one person is under more than
one boss then there can be contradictory orders and the subordinate fails to understand whose
order to be followed. In the absence of unity of command, the authority is undermined,
discipline weakened, loyalty divided and confusion and delays are caused.
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3. Unity of Direction:
To have effective direction, there should be one head and one plan for a group of activities
having the same objectives. In other words, each group of activities having the same
objectives must have one plan of action and must be under the control of one supervisor.

4. Direct Supervision:
The directing function of management becomes more effective if the superior maintains
direct personal contact with his subordinates. Direct supervision infuses a sense of
participation among subordinates that encourages them to put in their best to achieve the
organizational goals and develop an effective system of feed-back of information.

5. Participative or Democratic Management:

The function of directing becomes more effective if participative or democratic style of
management is followed. According to this principle, the superior must act according to the
mutual consent and the decisions reached after consulting the subordinates. It provides
necessary motivation to the workers by ensuring their participation and acceptance of work
methods.

6. Effective Communication:
To have effective direction, it is very essential to have an effective communication system
which provides for free flow of ideas, information, suggestions, complaints and grievances.

7. Follow-up:
In order to make direction effective, a manager has to continuously direct, guide, motivate
and lead his subordinates. A manager has not only to issue orders and instructions but also to
follow-up the performance so as to ensure that work is being performed as desired. He should
intelligently oversee his subordinates at work and correct them whenever they go wrong.

 ASPECTS OR ELEMENTS OF DIRECTION:

Directing is a very important function of management. It is rightly called the heart of
management process as it is concerned with initiating action. It consists of all those activities
which are concerned with influencing, guiding or supervising the subordinates in their job.

The main aspects or elements of direction are as follows:

 Issuing Orders and Instructions;
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 Leadership;

 Communication;

 Motivation;

 Supervision; and

 Co-ordination.

1. Issuing Orders and Instructions:

A manager is required to issue a number of orders to his subordinates to initiate, modify or
halt any action. He is also required to guide and instruct workers in performance of their task
towards the achievement of desired goals. Instructions are important in directing
subordinates. Orders and instructions reflect the decisions of managers.

A good order or instruction should have the following characteristics:

(a) It should be simple, unambiguous and clear.

(b) It should be brief but complete.

(c) It should be reasonable and enforceable.

(d) It should be convincing and acceptable.

(e) It should invoke co-operation.

(f) It should be compatible with the objectives of the organization.

(g) It should “be in written form as far as possible.

(h) It should be backed up by follow-up action.

2. Leadership:
Leadership is “the process by which an executive or manager imaginatively directs/guides
and influences the work of others in choosing and attaining specified goals by mediating
between the individual and organization in such a manner that both will get maximum
satisfaction.” It is the ability to build up confidence and zeal among people and to create an
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urge in them to be led. To be a successful leader a manager must process the qualities of
foresight, drive, initiative, self-confidence and personal integrity. Different situations may
demand different types of leadership viz., autocratic leadership, democratic leadership and
free-rein leadership.

Elements of Direction —The Management in Action:

3. Communication:
Communication constitutes a very important element of directing. It is said to be the number
one problem of management today. Communication is the means by which the behaviour of
the subordinates is modified and change is effected in their action.

The word communication has been derived from the Latin word ‘Communis’ which means
‘common’. Thus, communication means sharing of ideas in common. The essence of
communication is getting the receiver and the sender tuned together for a particular message.
Communication refers to the exchange of ideas, feelings, emotions, knowledge and
information between two or more persons.

In management ideas, objectives, orders, appeals, observations, instructions, suggestions etc.

have to be exchanged among the managerial personnel and their subordinates operating at
different levels of the organization for the purpose of planning and executing the business
policies. Directing will mainly depend upon the effectiveness of communication. In case the
orders and instructions are not properly conveyed then these may not be properly
implemented.

4. Motivation:
It is an important element of directing function. Motivation encourages persons to give their
best performance and help in reaching enterprise goals. It is the degree of readiness for
undertaking assigned task and doing it in the best possible way. Directing function tries to
make best use of various factors of production available in the organization. This can be
achieved only when employees cooperate in this task. Efforts should be made to make
employees contribute their maximum.
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5. Supervision:
It consists of the process and technique involved in issuing instructions and confirming that
operations are carried as originally planned. Supervision is a continuing activity and
performed at every level of activity. It is inevitable at every level of management for putting
the managerial plans and policies into action. In a way supervision is a sort of control as the
supervisor is supposed to take corrective measures if the work is not in line with the plan.

6. Co-ordination:
Co-ordination is an orderly arrangement of group effort to provide unity of action in pursuit
of common purpose. The purpose of directing is to get various activities coordinated for
achieving common goals. Co-ordination involves the integration of various parts of the
organization. In order to achieve goals of an enterprise, both physical as well as mental co-
ordination should be secured. Co-ordination is a part of directing exercise and helps in
synchronization of various efforts.

 IMPORTANCE OF DIRECTION:
Directing various employees in an organization is an important managerial task. It is
indispensable for achieving enterprise objectives.

Effective direction provides the following advantages:

1. Initiates Action:
Direction is required to initiate action. The functions of planning, organizing, staffing etc.,
will be taken up only when direction is given to initiate them. Direction starts the actual work
for achieving enterprise objectives.

2. Improves Efficiency:
A manager tries to get maximum work from his subordinates. This will be possible only
through motivation and leadership and these techniques are a part of direction.

3. Ensures Co-ordination:
Direction helps in ensuring mutual understanding and team work. The individual efforts are
directed in such a way that personal performances help in achieving enterprise objectives.
The integration of various activities is possible through direction.
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4. Helpful in Implementing Changes:

A business operates in a changing environment. New situations develop every now and then.
A proper system of motivation will help employees in taking up new challenges.

5. Provides Stability:
Effective leadership, supervision and motivation will help in the smooth growth of an
enterprise. A growing concern will provide stability to its activities.

6. Motivation:
Motivation is an important element of direction. Motivation is a factor which encourages
persons to give their best performance and help in achieving enterprise goals. A strong
positive motivation will enable the increased output of employees. A key element in direction
is motivation. It helps in getting willing co-operation of employees. Every organisation
makes efforts that its employees contribute maximum for achieving enterprise goals.

7. Supervision:
Direction involves giving instructions to employees for undertaking some work. In order to
see whether employees are doing the things as per targets or not there is a need for
supervision. In supervision all the activities of the employees are controlled and efforts are
made to ensure proper achievement of targets. In case the performance is less than the targets
then remedial steps are taken for improving the performance. So supervision is an integral
part of direction.

8. Co-ordination:
Direction will be effective only when there is a proper co-ordination. In direction, different
persons are asked to perform specific tasks. In order to see that efforts of every employee are
in the direction of achieving organizational goals there is a need to co-ordinate various
activities. In the absence of co-ordination every person will go in his own direction without
bothering for the enterprise target. When various activities are co-originated then overall
enterprise objectives will be easily achieved.

 TECHNIQUES OF DIRECTING:
Directing is an important function carried out by top management. It is the order or
instruction to subordinate staff to perform a work or not to perform in a specific way. The
techniques of directing are: delegation, supervision, orders and instructions.
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(i) Delegation:
Delegation is an important mean of directing. The subordinates are assigned tasks and given
powers to recruit them. In delegation, a superior assigns some of his work to the subordinates
and gives them rights or powers. The subordinates are authorized to undertake the assigned
work. Delegation is a means of sharing authority with the subordinates and providing them
with an opportunity to learn. Delegation as a means of directing may bring out some
problems.

(a) It may be difficult to spell out exact tasks and assignments of the subordinates. There may
be some overlapping and uncertainties in job descript ions. The subordinates should learn to
adjust them in such situations.

(b) There may be some contradiction in assignment of task and delegation of authority.

(c) The subordinates may sometimes act beyond the assigned authority taking it as implied
from the superiors. The superiors will have to bear with such situations.

(d) An indiscriminate delegation may create an imbalance in the organization since every
subordinate may not have the same capacity and maturity.

(e) If the delegation of authority is too rigid then it kills initiative and creativity.

(ii) Supervision:
Supervision is a means to oversee the work performed by subordinates. It should be ensured
that work is performed as per the plans and guidelines. Every superior has to supervise the
work of his subordinates. At operative level supervision is the job of a manager. A supervisor
at the lower level remains in touch with the workers. He guides them for doing the work,
maintains discipline and work standards and solves the grievances of workers. Supervision at
different levels acts as a directing activity.

(iii) Issuing Orders and Instructions:

The issuing of orders and instructions is essential to undertake the work for achieving the
organizational goals. No manager can get a work done without issuing orders and instructions
to subordinates. An order, instruction, directing or command is a means of initiating,
modifying or stopping an activity. In the words of Koontz and O’Donnel has a directional
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technique, an instruction is understood to be a charge (command) by a superior requiring a

subordinate to act or refrain from acting in a given circumstance.

According to this definition an instruction is always given by a superior to a subordinate

directing to undertake a work in a specified manner or prohibit him from some activity. The
orders and instructions are the primary tools of directing by means of which the activities are
started, altered, guided and terminated. While issuing an order a manager should be clear in
his mind what he wants the subordinates to do or not to do. The clarity of orders will
determine the level of performance of subordinates.

A good order has the following characteristics:

(a) The order should be clear and easily understood.

(b) The order should be complete in all respects. It should not create doubts in the minds of
subordinates.

(c) It should be compatible with the objectives of the organisation.

(d) There should be specific instructions as to the time by which the order should be executed
or completed.

(e) The order should be so conveyed that it stimulates ready acceptance.

(f) The order should preferably be in writing.

(g) The order should be conveyed through proper chain of command and it should also
contain the reasons for issuing it.

MOTIVATION
INTRODUCTION Motivation is an action that stimulates an individual to take a course of
action, which will result in an attainment of goals, or satisfaction of certain material or
psychological needs of the individual.
Motivation is a powerful tool in the hands of leaders. It can persuade convince and propel
people to act.
DEFINITION:-
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Motivation is defined as… Motivation is ―an inner impulse or an internal force that initiates
and directs the individual to act in a certain manner to satisfy a need.
Motivating force is a need that comes from within an individual, e.g. to make a living, gain
status and respect or to remove a source of frustration (Review of Maslow‘s Hierarchy of
Needs). ―Motivation refers to the way in which urges, drives, desires, aspirations, striving or
needs direct, control or explain the behavior of human beings‖. -Dalton E. McFurland

NEED FOR MOTIVATION:-

The nurse manager must realize that nurses have different personalities, work habits, and
what motivates one nurse may not motivate others. Meanwhile, some nurses are skilled,
confident, and capable of self-direction and seem to motivate themselves, while other nurses
lack self-confidence; they do their jobs poorly and have little motivation.
The nurse manager is responsible to motivate the second group and to improve their
performance. Researchers have revealed that job performance is the result of the interaction
of two variables; the ability to perform the task and the amount of motivation.
Job Performance = Ability + Motivation. Job dissatisfaction:
Job dissatisfaction contributes to higher turnover rates and decreased productivity and
considerable time and money are required to recruit and select a replacement for someone
who leaves the organization, it also takes time to socialize new employee to the
organizational culture, which is expensive time, beside that, other employees will need to
carry more load to cover the needs, and at last the kind of interruptions that results from the
loss of this employee.

For all those reasons the manager should be concerned about job satisfaction of employee,
and to do that there is a need to look at the different theories.

TYPES OF MOTIVATORS
1) Intrinsic motivation: Refers to motivation that comes from within the person, driving him
or her to be productive. It is related to a person‘s level of inspiration. The motivation comes
from the pleasure one gets from the task itself or from the sense of satisfaction in completing
or even working on the task rather than from external rewards.

2) Extrinsic motivation: It refers to motivation that comes from outside an individual, i.e.
enhanced by the work environment or external rewards such as money or grades. The
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rewards provide a satisfaction and pleasure that the task itself may not provide. An
extrinsically motivated person will work on a task even when they have little interest in it
because of the anticipated satisfaction they will get from the reward. e.g.- reward for a
student would obtain good grade on an assignment or in the class.

TYPES OF MOTIVATION
1) Achievement motivation
It is the drive to peruse and attain goals. An individual with achievement motivation wishes
to achieve objectives and advance up the ladder of success. Hence, accomplishment is
important for his/her own sake and not for the rewards that accompany it.
2) Affiliation motivation
It is a drive to relate to people on a social basis. Individuals with affiliation motivation
perform work better when they are complimented for their favourable attitude and co-
operation.

3) Competence motivation
It is the drive to be good at something, allowing the individual to perform high quality work.
Competence/skill motivated individuals seek job mastery, take pride in developing and in
using their problem solving skills and strive to be creative when confronted with obstacles.
They learn from their experiences.
4) Power motivation
It is the drive to influence people and change situations. Power motivated people wish to
create an impact on their organisation and are willing to take risks.

5) Attitude motivation
Attitude motivation is how people think and feel. It is their self-confidence, their belief in
themselves and their attitude to life. It is how they feel about the future and how they react to
the past.

6) Incentive motivation
It is where the people are motivated through external rewards. Here, a person or team reaps a
reward from an activity. It is the type of rewards that drive people to work harder.
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7) Fear motivation
Fear motivation coercions a person to act against will. It is instantaneous and gets the job
done more quickly. Fear motivation is helpful in the short run.

Methods of motivating employees / Motivational factors:

There are different methods which can be used for motivating employees .There can also be
treated as motivational factors/ forces/stimulators. They include monetary & non monetary
factors.

Monetary factors:

1) Salaries/wages: Money happens to be the most important motivation factor. While

determining salaries, management must give to employees security of income along
with ability to lead respectable life. Salary should be revised periodically to meet the
cost of living.
2) Bonus: Under the bonus payment Act,1965 a company has to declare bonus
whenever it earns profit. Bonus adds to annual income of the employees & it becomes
monetary incentive.
3) Incentives: When employees are paid over & above their salary, an additional
payment in recognition of better work, it is called incentive. When incentive payment
is offered, employees work hard to earn more & they remain motivated.
4) Allowances: Management providers to employees both statutory & non statutory
types of allowances such as medical allowance, educational allowance, house rent
allowance, recreation allowance, education allowance & so on .These allowance act
as motivators.
5) Special incentives : There are certain monetary incentives offered only to deserving
employees e.g. performance bonus, attendance etc. It has a positive impact on others
because they also work hard to earn these special incentives.

Non –Monetary factors:

1) Job Security & job enrichment: Job security is useful the motivation of employees.
Such security keeps the employee away from the tension of becoming unemployed.
Job enrichment provides an opportunity for greater recognition & advancement, job
enrichment refers to redesign of jobs.
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2) Fair treatment to employees: Employer should give attention to the needs,

difficulties & grievance of employees. Small work groups & effective communication
are useful for solving the problems of workers. Employees must be given decent
treatment. They will be co- operative only when they are treated with sympathy &
love, affection & dignity. Employees should also be given help in personal matters.
3) Recognition of good work: Recognition of good work at an appropriate time gives
encouragement to the employees to show better performance in future. As an
appreciation of good work, prizes rewards, promotions etc. should be given.
4) Encouragement to self-development & career development : Employees should be
given varied training facilities self- development & also provides opportunities for
career development. Every employee has a desire to grow, develop & rise higher. This
desire should be exploited fully for motivating employees. For this, training as well
as management development programme should be introduced.
5) Delegation of authority: Due to delegation of authority, a subordinate employee fells
that superior has faith in him & also in his ability to use authority in a proper manner.
Employees get mental satisfaction when authority is given to them. They take interest
& indicative in work & try to prove that they are competent to work at the higher
levels. Thus delegation of authority becomes a motivating factor.
6) Congenial working condition: It is a non-functional incentive for motivation.
Employees should be given various facilities & conveniences at the work place. The
work environment should be pleasant, safe & reasonably comfortable. This creates
desire to work efficiently.
7) Helpful attitude of management: The helpful attitude towards its employees creates
a sense of affinity for the organisation. Fair treatment to workers. Cordial industrial
relations also motivate employees. Thus ,enlightened & pro-employee attitude of
management acts as a motivating factor.
8) Fair opportunity of promotion: Fair opportunity of promotion to all eligible
workers is one more method useful for motivating employees. They take interest in
the work as they feel that they will be rewarded in the form of promotions. Training
facility should be provided to employees in order to make them eligible for
promotion.
9) Labour participation in management: Labour participation is useful for the
motivation of employees. Workers get higher status & better scope for expressing
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their views through such participation. Even the formation of quality circles or joint
management council is useful for motivating employees.
10) Designation & status: When an employee is provided with a better designation, it
adds to his status. Employees are proud to reveal their attractive & high-sounding
designations.

Characteristics/Features of motivation:-

1) Psychological process: Motivation is a psychological process useful encouraging

employees to take more interest & initiative in the work assigned. It relates to human
relations.
2) Initiative by manager: The initiative for motivation is to be taken by the manager by
offering guidance & also by other methods like appreciation of good work or offering
incentives.
3) Continuous activity: It is a continuous & circular process. Subordinates need
motivation in a continuous manner as their needs & expectations change from time to
time. A manager has to study the needs of the worker & use the technique of
motivation accordingly. The process of motivation must be made a regular &
continuous one.
4) Goal- oriented & action- oriented:- Motivation diverts human behaviour towards
certain goals. Attainment of organisational & individual goals depends on the
motivational plans.
5) Broad concept:- motivation is a comprehensive concept &cover needs, human
relations & satisfaction of employees. For employee motivation monetary & other
incentives need to be offered. Job satisfaction is one need of subordinates & is useful
for motivation.
6) Essence of management process:- Motivation is an essential function of a manager.
He has to motivate his subordinates for achieving organisational objectives.
Motivated force is an asset of business unit. Motivation employees bring success,
stability & prosperity to a business unit.
7) Beneficial to employees & management:- Motivation offers benefits to employees
& organisation. It avoids clashes & encourages cooperative outlook among
employees. Motivation leads to cordial labour- management relations. It provides
more profit to management & better welfare to employees.
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8) Varied measures available for motivation: For motivation various monetary & non
monetary incentives can be offered to employees by the management. Attractive
wages, welfare facilities, job security & fair treatment are some measures of
motivating employees.
Importance of motivation of employees:-
Nature of motivation
Unending process: human wants keep changing & increasing.

A psychological concept: deals with the human mind.

Whole individual is motivated: as it is based on psychology of the individual.

Motivation may be financial or non-financial: Financial includes increasing wages,

allowance, bonus, etc.

Motivation can be positive or negative: positive motivation means use of incentives -

financial or non-financial. E.g. of positive motivation: confirmation, pay rise, praise
etc. Negative motivation means emphasizing penalties. It is based on force of fear.
Eg. demotion, termination.

Motivation is goal-oriented behaviour.

Motivation is an internal feeling of an individual. It can‘t be observed directly; we can

observe an individual‘s action and interpret his behaviour in terms of underlying
motives. This leaves a wide margin of error. Our interpretation may not reveal the
individual‘s true behaviour.

Motivation is a continuous process that produces goal directed behaviour. The

individual tries to find alternatives to satisfy his needs.

Motivation is a complex process. Individual may differ in their motivation even

though they are performing the same type of job. For example, if two men are
engaged in cutting stones for constructing a temple, one may be motivated by the
amount of wages he gets and the other by the satisfaction he gets by performing the
job.

COMPONENTS OF MOTIVATION
Motivation comprises of three main components:
Direction
Effort
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Persistence

We start off by deciding what we want, which is our direction as we know where we want to
go and what we have to achieve. Then we make an effort towards our goal. We start to do
things and we continue our making the efforts for some time and give it everything that we
have. Now comes the part where we have to be persistent with our efforts and keep doing
them.

SOURCES OF MOTIVATION
1) Internal or push forces:
Needs
For security
For self-esteem
For achievement
For power
Attitudes
About self
About job
About supervisor
About organization
Goals
Task completion
Performance level
Career advancement

2) External or pull forces:

a. Characteristics of the job

Feedback

Amount

Timing

Work load

Tasks
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Variety

Scope

Discretion

How job is performed

b. Characteristics of the work situation

Immediate Social Environment

Supervisor(s)
Workgroup members
Subordinates
Organizational actions
Rewards & compensation
Availability of training
Pressure for high levels of output

REQUISITES TO MOTIVATE
 We have to be Motivated to Motivate
 Motivation requires a goal
 Motivation once established, does not last if not repeated

 Motivation requires Recognition

 Participation has motivating effect

 Seeing ourselves progressing Motivates us

 Challenge only motivates if you can win

 Everybody has a motivational fuse i.e. everybody can be motivated

 Group belonging motivates .

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In the initiation, a person starts feeling lacknesses. There is an arousal of need so urgent, that
the bearer has to venture in search to satisfy it. This leads to creation of tension, which urges
the person to forget everything else and cater to the aroused need first. This tension also
creates drives and attitudes regarding the type of satisfaction that is desired. This leads a
person to venture into the search of information. This ultimately leads to evaluation of
alternatives where the best alternative is chosen. After choosing the alternative, an action is
taken. Because of the performance of the activity satisfaction is achieved which than relieves
the tension in the individual.
CREATING A MOTIVATING CLIMATE
As the organization has an impact on intrinsic and extrinsic motivation, it is important to
examine organizational climates or attitudes that influence workers morale and motivation.
Employees want achievement, recognition and feedback, the opportunity to assume
responsibility, a chance for advancement, fairness, good leadership, job security and
acceptance and adequate monetary compensation. All these create a motivating climate and
lead to satisfaction in the work place. e.g. nurses who experience satisfaction stay where they
are, contributing to organization‘s retention.
STRATEGIES TO CREATE A MOTIVATING CLIMATE
1. Have a clear expectation for workers and communicate effectively.

2. Be fair and consistent when dealing with all employees.

3. Be a firm decision maker.

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4. Develop a team work/team spirit.

5. Integrate the staffs needs and wants with the organization‘s interest and purpose.

6. Know the uniqueness of each employee.

7. Remove traditional blocks between the employee and the work to be done.

8. Provide opportunities for growth.

9. Encourage participation in decision-making.

10. Give recognition and credit.

11. Be certain that employees understand the reason behind decisions and actions.

12. Reward desirable behaviour.

13. Allow employees exercise individual judgement as much as possible.

14. Create a trustful and helping relation with employees.

15. Let employees exercise as much control as possible over their work environment.

Leadership Roles and Management Function Associated With Creating A Motivating

Work Climate:- Leadership Roles:
1. Recognize each worker as unique individual who is motivated by different things.

2. Identifies the individuals and collective value system of the unit and implements a reward
system that is consistent with those values.

3. Listen attentively to individual and collective work values and attitudes to identify unmet
collective needs that can cause dissatisfaction

4. Encourage workers to ―stretch‖ themselves in an effort to promote self growth and self
actualization.

5. Maintains a positive and enthusiastic image as a role model to subordinates in the clinical
setting

6. Encourage mentoring, sponsorship and coaching with subordinates.

7. Develop time and energy to create an environment that is supportive and encouraging to
the discouraging individual.

8. Develop a unit philosophy that recognizes the unique worth of each employee and promote
reward systems that make each employee feel like a winner.
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9. Demonstrates through actions and words a belief in subordinates that they desire to meet
organizational goals.

10. Is self- aware regarding own enthusiasm for work and takes steps to motivate self as
necessary.
MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE NURSES
MOTIVATION: - The nurse manager while managing the nursing unit will have to choose a
combination of the following measures to facilitate nurses‘ motivation.
1) Act as a Role model (Set a good example):-
a) Set high standards in the units.
b) Maintain a positive attitude towards the work and staff.
c) Be optimistic; in other words, be aware of how difficult the job is and how it can be done.
d) Ask for help when in need.
e) Admit mistakes.
2) Develop and maintain Good Personal Relations:-
a) Use two-way communication.
b) Be friendly, not to criticize staff in front of others and be fair.
c) Keep a sense of humor and avoid getting angry.
d) Try to understand nurses‘ attitudes, likes, dislike their experience, previous training,
problems in their work and needs.

These measures will help in understanding nurses‘ behavior. Understanding is the first step
toward motivating nurses. Trust comes with understanding and it develops slowly based on
the respect and acceptance of the manager. Motivation is based on understanding and trust.
Some guidelines for developing trust:-
a) Apply rules equally and consistently.

b) Avoid favoring some nurses over others, be fair.

c) Share information – show respect for ideas and opinions and confidentiality.

d) Be supportive at all times.

3) Post Each Nurse where she can work best:-

The nurse is more likely to succeed and be motivated if her/his interests and skills are
considered in the assignment. Success is the best motivator.
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4) Use a participative style:-

Participation and sharing information will motivate nurses since they feel they are taking part
in decisions. Motivation requires more than physical involvement in a job. It also demands
mental and emotional involvement.

5) Guide, encourage and support continuously:-

Guidance means helping nurses in planning, evaluating their work and in solving work and
personal problems.. Encouragement means helping and reassuring nurses regardless of the
type of problems. Develop a supportive environment by reducing physical stresses associated
with the job. Support means removing obstructions and providing nurses with satisfying work
environment which include personnel and facilities and suitable learning materials needed to
do their job.
Reward Good work:-
a) Give recognition for successful achievement of the job. Praise frequently and informally. It
can be in front of other staff.

b) Reward includes: Pay increase, promotion, training for advancement to a higher level
within a job.

c) Thank you is a type of reward that helps to increase self-confidence.

6) Build team work (Team spirit)

a) Schedule regular meetings.
b) Make nurses feel that their job is important to the success of the team.
c) Integrate the needs and wants of the staff nurses with those of the nursing unit.
d) Think of nurses in the unit as a group and do what is best for them.

7) Provide continuing education:-

Nurses enjoy learning new knowledge and skills or updating the existing knowledge and
skills or taking new responsibilities through continuing education.

SYMPTOMS OF MOTIVATED NURSES:-

1. Show interest, enthusiasm and have a positive attitude.
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2. Believe their work is important and work hard.

3. Work well with their supervisors and others.

4. Take part willingly in planning, implementing and evaluating their work.

5. Show responsible behaviour.

Strive to find the best way to produce optimal job performance.

THEORIES OF MOTIVATION The word motivation theory is concerned with the

processes that describe why and how the human behaviour is activated and directed. It is
considered as one of the most important areas of study in the field of organizational
behaviour. There are two different categories of motivation theories- the content theories and
the process theories.

A) Content theories of motivation

This is also called as the Need theory. It mainly focuses on the internal factors that energize
and direct human behaviour. Some of the need theories are-

1) Abraham Maslow (1943)

Maslow‘s theory included 5 basic needs in his theory, namely the- The physiological needs,
Safety and security needs, Love needs, self-esteem needs and self-actualization needs.
Maslow suggested that human needs are ordered in a hierarchy from simplex to complex.
Higher level needs do not emerge as motivators until lower needs are satisfied and a satisfied
need no longer motivates behaviour.
Physiological needs: Food, water, warmth, shelter, sleep, medicine and education, etc.
Once the physiological needs are met, the next level becomes predominant.
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Safety and security needs: These are the needs to be free of physical danger and of the
fear of losing a job, property, food or shelter. It also includes protection against any
emotional harm.

Social needs: Since people are social beings, they need to belong and be accepted by
others. People try to satisfy their need for affection, acceptance and friendship. After the
lower needs are well satisfied, affiliation or acceptance will emerge as dominant and the
person strives for meaningful social relationship.

Esteem needs: According to Maslow, once people begin to satisfy their need to belong,
they tend to want to be held in esteem both by themselves and by others. This kind of need
produces such satisfaction as power, prestige status and self-confidence.

Need for self-actualization: Maslow regards this as the highest need in his hierarchy. It
is the drive to become what one is capable of becoming; it includes growth, achieving one‘s
potential and self-fulfilment. It is to maximize one‘s potential and to accomplish something.

2) Alderfer ERG theory

ERG theory is similar to Maslow‘s hierarchy of needs. The existence (E) needs are
equivalent to physiological and safety needs; relatedness (R) needs to belongingness, social
and love needs. The growth (G) needs to self-esteem and self actualization- personal
achievement and self-actualization. The major conclusions of this theory are:
In an individual, more than one need may be operative at the same time.
If a higher need goes unsatisfied than the desire to satisfy a lower need intensifies.

When the higher level needs is frustrated; people will regress to the satisfaction of the
lower-level needs. This phenomenon is known as frustration-regression process

3) Frederick Herzberg Two Factor need theory (1966)

Herzberg felt that job satisfaction and dissatisfaction exists on dual scales. Workers are
motivated by two types of needs/factors-
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Needs relating to the work itself called intrinsic/motivation factors (satisfiers):

challenging aspects of the work, achievement, added responsibility, opportunities for growth
and opportunities for advancement

Needs relating to working conditions called extrinsic/hygiene factors (dissatisfiers):

salary, status, working conditions, quality of supervision, job security and agency policies.

According to Herzberg, the hygiene factors must be maintained in quantity and quality to
prevent dissatisfaction. They become dissatisfiers when not equitably administered, causing
low performance and negative attitudes. The motivation factors create opportunities for high
satisfaction, high motivation and high performance. Absence of motivation factors causes a
lack of job satisfaction.

4) David McClelland(1961)
David McClelland has developed a theory on three types of motivating needs:
Need for Power

Need for Affiliation

Need for Achievement

People with high need for power are inclined towards influence and control. They like to be
at the center and are good orators. They are demanding in nature, forceful in manners and
ambitious in life. They can be motivated to perform if they are given key positions or power
positions. In the second category are the people who are social in nature. They try to affiliate
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themselves with individuals and groups. They are driven by love and faith. They like to build
a friendly environment around themselves. Social recognition and affiliation with others
provides them motivation. People in the third category are driven by the challenge of success
and the fear of failure. Their need for achievement is moderate and they set for themselves
moderately difficult tasks. They are analytical in nature and take calculated risks. Such
people are motivated to perform when they see atleast some chances of success. McClelland
observed that with the advancement in hierarchy the need for power and achievement
increased rather than Affiliation. He also observed that people who were at the top, later
ceased to be motivated by this drives.

5) McGregor‟s Theory X and Theory Y

Douglas McGregor proposed two different motivational theories- theory X and theory Y. He
states that people inside the organization can be managed in two ways. The first is basically
negative, which falls under the category X and the other is positive, which falls under the
category Y.
Assumptions of theory X:
Employees inherently do not like work and whenever possible, will attempt to avoid it.

Because employees dislike work, they have to be forced, coerced or threatened with
punishment to achieve goals.

Employees avoid responsibilities and do not work until formal directions are issued.

Most workers place a greater importance on security over all other factors and display little
ambition.

Assumptions of theory Y:
Physical and mental effort at work is as natural as rest or play.

People do exercise self-control and self-direction and if they are committed to those goals.

Average human beings are willing to take responsibility and exercise imagination,
ingenuity and creativity in solving the problems of the organization.

That the way the things are organized, the average human beings brainpower is only partly
used.
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On analysis of the assumptions it can be detected that theory X assumes that lower-order
needs dominate individuals and theory Y assumes that higher-order needs dominate
individuals. An organization that is run on Theory X lines tends to be authoritarian in nature-
―power to enforce obedience‖ and the ―right to command.‖ In contrast Theory Y
organizations can be described as ―participative‖, where the aims of the organization and of
the individuals in it are integrated; individuals can achieve their own goals best by directing
their efforts towards the success of the organization
B) Process theories of motivation
Process theories of motivation provide an opportunity to understand thought processes that
influence behaviour. The major process theories are- Vroom‘s expectancy theory, goal-
setting theory and reinforcement theory.

1) Reinforcement theory
B.F. Skinner‘s theory (1969) suggests that an employee‘s work motivation is controlled by
conditions in the external environment, that is, by designing the environment properly,
individuals can be motivated. Instead of considering internal factors like impressions,
feelings, attitudes and other cognitive behaviour, individuals are directed by what happens in
the environment external to them. Skinner states that work environment should be made
suitable to the individuals and that punishment actually leads to frustration and de-
motivation. Hence, the only way to motivate is to keep on making positive changes in the
external environment of the organization. Positive behaviour should be reinforced or
rewarded as this increase the strength of a response or induces its repetition. Reinforcers tend
to weaken over time and new ones have to be developed. Negative reinforcement occurs
when desired behaviour occurs to avoid negative consequences of punishment. Punishment
creates negative attitude and can increase costs.

Expectancy theory of Vroom

This theory postulates that most behaviours are voluntarily controlled by a person and are
therefore motivated. It focuses on people‘s effort-performance expectancy, or a person‘s
belief that a chance exists for a certain effort to lead to a particular level of performance. This
theory states that motivation depends on three variables-
Attractiveness: the person sees the outcome as desirable.
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Performance-reward linkage: the person perceives that a desired outcome will result
from a certain degree of performance.

Effort-performance: the person believes that a certain amount of effort will lead to
performance.

3) J. Stacy Adams Equity theory

Third process theory and focuses on fair treatment. Persons believe that they are being treated
with equity when the ratio of their efforts to rewards equals those of others. Equity can be
achieved or restored by changing outputs, attitudes, the reference person, inputs or outputs of
the reference person or the situation. People have a tendency to use subjective judgment to
balance the outcomes and inputs in the relationship for comparisons between different
individuals. Accordingly,

4) Jeremy Bentham‟s “The Carrot and the Stick Approach”

English philosopher, Jeremy Bentham ideas developed his ideas in the early years of the
Industrial Revolution, around 1800. Bentham‘s view was that all people are self-interested
and are motivated by the desire to avoid pain and find pleasure. Any worker will work only if
the reward is big enough, or the punishment sufficiently unpleasant. With this view, the
 30

‗carrot and stick‟ approach was built into the philosophies of the age. This metaphor
relates to the use of rewards and penalties in order to induce desired behaviour. It came from
the old story that to make a donkey move, one must put a carrot in front of him or dab him
with a stick from behind. Despite all the research on the theories of motivation, reward and
punishment are still considered strong motivators. In almost all theories of motivation, the
inducements of some kind of ‗carrot‘ are recognized. Often this is money in the form of pay
or bonuses. Even though money is not the only motivating force, it has been and will
continue to be an important one. The trouble with the money ‗carrot‘ approach is that too
often everyone gets a carrot, regardless of performance through such practices as salary
increase and promotion by seniority, automatic ‗merit‘ increases, and executive bonuses not
based on individual manager performance.
The ‗stick‘, in the form of fear–fear of loss of job, loss of income, reduction of bonus,
demotion, or some other penalty has been and continues to be a strong motivator. It often
gives rise to defensive or retaliatory behaviour, such as union organization, poor-quality
work, executive indifferences, and failure of a manager to take any risks in decision-making
or even dishonesty. However, fear of penalty cannot be overlooked. Whether managers are
first-level supervisors or chief executives, the power of their position to give or with hold
rewards or impose penalties of various kinds gives them an ability to control, to a very great
extent, the economic and social well-being of their subordinates .

5) Goal-setting theory of Edwin Locke :-

This theory is based on goals as determinants of behaviour. The theory states that when the
goals to be achieved are set at a higher standard than, employees are motivated to perform
better and put in maximum effort. The more specific the goals, the better the results
produced. The goals must be achievable, and their difficulty level must be increased only to
the ceiling to which the person will commit. Goal clarity and accurate feedback increases
security. It revolves around the concept of ―Self-efficacy‖ i.e. individual‘s belief that he or
she is capable of performing a hard task.

6) Arousal/ Cognitive Evaluation theory:-

Focuses on internal processes that mediate the effects of conditions of work on performance.
This theory states, a shift from external rewards to internal rewards results into motivation. It
believes that even after the stoppage of external stimulus, internal stimulus survives. It relates
to the pay structure in the organization. Instead of treating external factors like pay,
 31

incentives, promotion etc and internal factors like interests, drives, responsibility etc,
separately, they should be treated as contemporary to each other. The cognition is to be such
that even when external motivators are not there the internal motivation continues.

7) Attitude theory
Focuses on favorable attitudes of job satisfaction and job involvement leading to high
performance.

8) Attrition/self-efficacy theory
Focuses on explanations for events or behaviour. Perceptions of self efficacy and self esteem
affect performance.

Motivational theories for Better Nursing Management

The needs of an individual are important motivators. These make the person work with
enthusiasm & interest. The significant individual needs are: * Need for Power: Which results
in a strong desire to influence staff, stimulate them to work, making them achieve positions
of leadership e.g. making the nursing supervisor wholly responsible to take care of whole
ward. The need for achievement results in a desire to do something better or more efficiently
than others. People with a high need of achievement have an intense desire for success &
equally intense fear of failure. They want to be challenged, prefer to assume personal
responsibility to get work done and like to work for long hours. Training and orientation
(refresher) course increase this need. All the staff working in a particular area should be given
equal chance to attend the refresher courses related to that particular area.
* Need for affiliation: - Some people derive pleasure from being loved and tend to avoid the
pain of being rejected by social group. They enjoy social relationships, intimacy, empathise
and help others in trouble. There is close intimacy when a staff nurse is allowed to plan and
decide patient care along with ward supervisor. In order to satisfy the employees, a manger
can also use Maslow's Motivation Theory in these ways:
* Improving physical working conditions to satisfy needs e.g. grilled door and escorts to
secure the nursing staff at night, providing rest rooms for lunch and dinner.
* Increasing the level of training, development and skill in order to meet the self esteem
needs e.g. uniform, leave facilities, vacation to nursing students. If these facilities are
inadequate it harms their self esteem.
* Having congenial social group and peer group interaction to fulfill affiliation needs.
 32

* Placing the person in position which match their self concept to fulfill the self actualization
need. Job Design Job design is another motivator to satisfy, signify and give value to
employees encouraging them to perform well. Koul Jyoti conducted a study on job
satisfaction of 126 staff nurses of different hospitals in J&K State and showed that only 8%
were highly satisfied. Maximum satisfaction was found for the work itself and with the
competency of supervision. The areas of best satisfaction were concerned with material
rewards and individual agency. The older age group and experienced persons were found
more satisfied. Work Environment There are many conditions in the environment which
could possibly effect the motivation of staff. It is seen by Behaviour Modification Theorist
that employees perform positively if environment is favourable which is made by pay/
reward policies, democratic leadership style, peer group interaction etc. To effect the
performance of employees, their input (e.g. efforts, training, experience, skill, education,
seniority) should be equitable to their output e.g. pay, rights, benefits, job-status, status
symbol's (vacation, clothing, satisfactory superior). The employees feel inequity if
unrewarded or if given undesirable placement. The employees always respond to the
environment & these responses influence their behaviour. A nursing Manager can accomplish
this by using following motivational techniques.
* Positive Reinforcement: Annual reward for better performance in the form of money,
recognition, praise, promotion etc. Give reward to the most clean and best patient care ward
on Annual days.
* Avoidance Learning: Some staff nurses improve their behaviour in order to avoid criticism
of Nursing. Superintendent or to avoid any disciplinary action against her.
* Punishment: Nursing Superintendent, for example, can withhold reward or promotion so as
to change the behaviour of staff. Scolding in front of others or humiliating should be avoided.
* Be sure to tell a person she / he is doing wrong and what type of behaviour is desired e.g.
RT feeding given with force by use of piston should be corrected and demonstrated so that
goes with gravity.
* Making the staff participate in different activities which give them affiliation, acceptance
and recognition, e.g. in conferences, Nurses'-Day, Hospital Annual Day etc.
* Giving feeling of personal responsibility or keeping interactions. The newly appointed staff
should be left independent but be observed closely.
* Warmth, support and identity motivate the staff to perform better. Every staff member has
her own potential. Respect their individual capabilities. Don't scold if she is performing badly
in other field. Let her develop potential gradually.
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PROBLEMS IN APPLYING MOTIVATION THEORIES

This article presents a non-exhaustive account of some problems in applying motivational
theories to the actual conditions of the workplace. It should give readers a general idea of
some of the less effective and more effective methods for motivating employees.

Reward vs. Punishment

It is generally conceded that while rewards can offer workers a variety of incentives which
can not only motivate them to work harder but also produce feelings of good-will towards
management, punishment often functions only to cultivate feelings of hostility between
managers and workers, which can directly and negatively effect productivity.

Personal Satisfaction vs. Financial Satisfaction

One of the most successful ways of fostering a productive and motivated workforce is to
ensure that workers are satisfied with their jobs, not just with their pay. It is interesting to
note that people are quite often more concerned with how much they like their job than they
are with how much money they actually make. Making employees feel important in the
workplace can make them feel like part of the team, which makes them feel personally
invested in the health of a business.

Persuasion vs. Coersion

By appealing to a worker's sentiments and reason a manager can persuade a worker to take
initiative and build their morale, which are internal drivers of motivation. However, by
appealing to fear and coercion a manager may actually cause a decline in internal motivation,
leaving instead feelings of hostility or anxiety which can negatively affect production.

Knowing Your Workers

Understanding what is important to an individual is endemic for understanding how to
motivate that person effectively. Is an individual motivated by the opportunity to develop
professionally or by the possibility of making more money? Does he or she want more
responsibility or more clearly defined responsibilities? Is it important that he or she see the
end-product of their work or not? Usually, employees are not motivated by just one thing,
which can make it difficult to determine the best strategy for motivation.
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Involvement
One of the top things leading workers to feel productive and motivated in the workplace
knows that they have a good management team. When people feel close to their managers
they oftentimes do not want to disappoint, and may even feel the desire to win approval. By
being invested in workers, managers can get workers to feel reciprocally invested in their
workplace and their work. Fostering motivation in the workplace is first and foremost about
fostering good management practices.

METHODS FOR MOTIVATING EMPLOYEES

1. Job rotation: This is also known as cross training. It can be effective for employees that
perform repetitive tasks in the job. This allows the employees to learn new skills by shifting
them from one task to another.

2. Job enlargement: is a motivation technique used for employees that perform a very few
and simple tasks. It increases the number and variety of tasks that the employee performs,
resulting in a feeling of importance

3. Job enrichment: this method increases the employees control over the work being
performed. It allows the employees to control the planning, execution and evaluation of their
own work, resulting in freedom, independence and added responsibility.

4. Flexible time: this allows the employees to choose their own work schedule to a certain
extend.

5. Job sharing: a less common method but very effective in preventing boredom. It allows
employees to share two different jobs

6. Employee involvement: people want to feel like they are a part of something. Letting the
employees to be more active in decision-making related to their job makes them feel valued
and important to the company and increases job motivation.

7. Variable pay programs: merit based pay, bonuses, gain sharing, and stock ownership
plans are some good motivators for employees. They should be offered as an incentive or
reward for outstanding performance.
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The six commonly used motivational approaches:

The motivational approach are the means by which administration attempt to influence the
employee to accomplish the work of an organisation.

There are six commonly used motivational approaches:

 Directiveness
 Paternalisim
 Compromise
 Competition
 Participation
 Path-need motivation

Directiveness: Directiveness is based on authority & economic rewards. The

leadership is autocratic & the motivator usually is “fear”. In short-terms, directiveness
may produce beneficial result, but in most situation its principal outcome is
organisational mediocrity specially seen in the long run.
Paternalism: Paternalism is a motivational approach based on fatherly treatment of an
employee. It is based on two beliefs, i.e., be good to employees & they will be
grateful & loyal in turn,& make them happy to become part of the organisation or
work group, so that they will work harder. Paternalism can make people happy, but it
is not likely to provide through job satisfaction.
Compromise:

BOOK REFERENCES
A. G. Chandorkar. Management for Health care professional. Paras medical publisher,
page no.583-621
Neelam kumari. Management of Nsg. Services and education, 3rd edition 2011. p. v.
books editors page no.293-300.
 36

Dr. S. R. Pandya. Administration and management of education, 4th revised edition

2011. page no. 263-278.
Basavanthappa B T, Nursing administration. 2nd edition. Jaypee Brothers Medical
Publishers; St Louis USA;2009.page no. 109-134
Barriet J. Ward management and Teaching. 2nd ed. Delhi: EBS Publishers; 1967
Ward MJ, Price SA .Issues in nursing administration. St. Louis: Mosby; 1991.
Marquis B. L. ,Hutson C.J . Leadership roles and management functions in nursing–
Theory and application. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.
Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis;
1996.