Employee morale relates to the esprit de corps, the enthusiasm, confidence, and zeal in a group or individual to attain a particular goal or accomplish a particular task; it is a mental attitude among groups and individuals which determines their capacity to co-operate. Good employee morale is often exhibited by a worker’s enthusiasm, his proclivity to cooperate with other employees in accomplishing the company’s objectives, and his capacity to conform to the company’s orders and regulations voluntarily (Dotson et al ., 2014). Poor morale is often exhibited by insubordination, surliness, and the feeling of disdain towards one’s job, associates, and organization. Morale, whether negative or positive may impact various aspects in one’s profession; they include employee productivity, employee attitude, an employee’s daily decisions, workplace safety, punctuality and attendance, and relationships with management and co-workers. High morale within the workforce is crucial to the overall success of a particular business.
High morale enhances high productivity levels, low employee turnover, increased attention to specific details, workplace safety, increased communication amid the management and co-workers, and increased focus on consumers or outcomes. There is an increased global attention directed towards the research on nursing workforce issues, for instance, workplace health issues, employee turnover rates, and retention and recruitment by various administrators, policymakers, and researchers. The contemporary literature links issues such as staff turnover rates, recruitment and retention, health issues, for instance, health risks and increased employee accidents, and absenteeism to low morale (Dotson et al ., 2014). Due to low morale, these poor organizational upshots cause the company to incur significant losses, and they generate consequential impacts on the employees’ health and wellbeing; this, in turn, exposes patients to the risk of potentially unpropitious clinical outcomes and low-quality care.
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Factors Impacting Nurses’ morale and Retention Rates
Various studies aimed at evaluating the poor morale amid healthcare employees attribute poor healthcare employees’ morale to various factors: Shortage of health care workers, professional prospects and support, the quality of nursing education, low compensation rates, issues with the recruitment and retention of healthcare staff, overworking, and the lack of professional achievement and job performance recognition ( Collini, Guidroz & Perez, 2015 ). An individual’s response or reaction towards a particular task and organizational stimuli has an influential bearing on one’s consequent perception of morale in the workplace. Factors impacting nurses’ morale may be categorized into two major categories: Intrinsic and extrinsic factors.
Intrinsic Factors
Intrinsic factors relate to the variables that affect a nurse’s conceptualization of professional or personal position within a grouping. Nurses often have some level of control over the intrinsic factors that affect their morale levels. These factors include:-
Work Groupings/relationships
According to Mazurenko, Gupte and Shan (2015), workplace relations amid nurses may have a crucial effect on their morale. In his study, he examined the significance of group and social interactions and its impact on the conceptualization of morale and inferred that the stability of the grouping’s cohesion relies on morale. The findings present a basis for the positive evaluation of social interaction and its effectiveness in the achievement of a group’s objectives and teamwork. For instance, in one quantitative research (n=223) aimed at assessing nurse turnover, kinship relationships was considered as an effective variable. Social interactions amid nurses are critical in establishing an effectual teamwork in the workplace and the attainment of the set goals by the organization. In the study, working relations extended above the relationships established within a craft grouping, with nurses exhibiting an improved morale in instances where professional relations with physicians were considered positive. The outcome revealed that whenever there is a supportive professional relationship with the medical staff, nurses recorded that their occupation was very meaningful and fulfilling, they effectively utilized their professional expertise and knowledge, and they rarely thought of resigning. Additionally, the researchers inferred that turnover rates and absenteeism were reduced significantly due to a potent work-group relation and sense of community promoted by the nurse manager.
Professional Respect/Worth
Professional worth and respect is a critical motivator for an organization’s employees. Whenever service constraints are placed above the organization’s value for its staff, the organization often experiences a decrease in employee morale thereby, resulting in a minimal output quality and standard which subsequently leads to a significant loss of skilled human resource and a spiral of decline. Research involving nurses who work in the operating room (n=46), revealed the effectiveness of inclusiveness and professional worth on the nurses’ morale. Another study evaluating the professional worth of nurses in a hospital setting revealed that the hospital’s hiring of an agency or temporary staff alongside its permanent staff impacted the morale of its permanent employees (Mazurenko, Gupte & Shan, 2015). A significant number of respondents reported that staff nurses (permanent) resented the high rates of compensation given to temporary staff claiming that the temporary staff did not provide the same quality of care as permanent nurses nor did they identify with the goals of the hospital.
Patient Care
The delivery of quality care by nurses is an important variable used to determine nurses’ morale. Nurses working in invigorating environments often exhibit high levels of morale. A large quantitative research conducted in the U.S and involving various health care practitioners such as midwives and nurses revealed that there are two primary factors which dominated the nurses’ perception of morale within their workplaces (Mazurenko, Gupte & Shan, 2015). These factors include the discerned capacity to provide good patient care and the effective collegiate relations with co-workers. The study further outlined other crucial elements that impact a nurse’s perception of morale; they include professional worth and respect, the provision of opportunities for professional development, and the capacity to use their diversified expertise and exercise responsibility; these factors significantly impacted turnover rates.
Skill Development /Promotional Opportunities
A quantitative research involving nurses under the U.S health sector revealed that many nurses reported that they had been constrained from utilizing or developing their proficiencies due to various factors such as the poor promotion prospects (Mazurenko, Gupte & Shan, 2015). In the study, certain variables exhibited a significant correlation; they include regard and recognition, workload, quality of care, professional development, decision-making/autonomy, and working relationships. Additionally, the study deduced that although these nurses delivered a high health care quality, their morale was wretched due to various organizational factors, for instance, low levels of employee staffing, lack of adequate resources, and increased workload; these factors subsequently impacted the nurse’s turnover rates. In another research, the study group’s poor morale was ascribed to the lack of opportunities for professional advancement; this includes training, education, and promotional opportunities.
Extrinsic Factors
Extrinsic elements involve those variables controlled by an organization or various external factors these elements are often out of an individual’s control. These factors include:-
Structural/Organizational Factors
Organizational components such as training and development, communication, management styles, and communication are often cited as the primary organizational variables that impact the level of employee morale amid healthcare practitioners. For instance, a study conducted by Collini, Guidroz and Perez in 2015 , reveals that job satisfaction often influences various organizational factors which in turn aggravates staff morale and employee turnover. The research further outlines interpersonal relations, supervision, job interest, organizational policy, recognition, working conditions, autonomy, and responsibility as the variables that impact employee morale. Low employee morale may also be attributed to organizational factors such as organizational structures, benefit policies, and the transitions in scheduling practices. A study (n=42) aimed at assessing the relationship amid anxiety, vulnerability, and ineffective coping skills and morale revealed that these elements often impact employee morale negatively thereby, leading to a significant increase in errors and accidents, illnesses and sick leave, and the need to find employment opportunities in other institutions.
Staffing
Staffing is a significant factor which often impacts employee morale. A study (n=1695) aimed at analyzing the effect of the low employee staffing on employee morale in health care institutions revealed that nurses who were assigned in units typified by low staffing and poor work environment were more likely to record high-risk factors, high turnover rates, and accidents such as needlestick injuries than nurses assigned in units with good work climate and proper staffing ( Kumat-Thoma et al ., 2017). Additionally, another research aimed at assessing an organization’s capacity to improve the nurses’ morale in a cost containment environment deduced that nursing administrators ought to institute organizational responses to morale issues amid nurses to improve the organization’s productivity and keep up with the changing healthcare technologies. The researcher used various variables to assess morale; they include promotional opportunities, learning opportunities, autonomy, recognition, workload, the level of responsibility, relationships amid co-workers, the use of skills, and work plans. The study also deduced that various organizational elements impact employee morale; these factors include heavy workloads due to understaffing, opportunities for career advancements such as learning opportunities, poor communication, and poor grading systems. Nurses’ low morale has also been reviewed with regards to its impact on retention and recruitment. A three- year longitudinal research involving nurses (n=520) aimed at evaluating variables such as work environment and employee morale revealed that an increased tension existed amid the pressures due to workload and the need to provide a holistic patient care; this, in turn, had an adverse effect on employee morale which subsequently led to high turnover rates ( Kumat-Thoma et al ., 2017). In the study, low morale was associated with the understaffing and the aging nursing workforce.
Organizational Structures
Studies indicate that there are a number of hospitals which are perceived as market leaders due to the low turnover rates and high employee morale; these hospitals are commonly referred to as magnet hospitals ( Kumat-Thoma et al ., 2017). Since hospitals cannot increase incentives and wages, they often concentrate their primary efforts on improving the employees’ work environment. Magnet hospitals often adopt features such as decentralized organizational structures, flexible work schedules, career advancement opportunities, adequate staffing, professional responsibility and autonomy, and supportive management forms, therefore, able to attract and retain highly-qualified nurses. Additionally, magnet hospitals often promote high nurse morale by enhancing employee stability and job satisfaction.
Leadership/Communication
To enhance an improved employee morale, the organization ought to have a shared vision and a common perception of the occupational pressures and issues amid the employees and management. The conceptualization of shared ownership is often perceived as an important factor which contributes to a high employee morale amid staff. Morale is typified by three major dimensions: Personal challenge, leadership challenge, and cohesive pride. A quantitative research involving 910 nurses in Australia revealed that employee morale was highly impacted by workload issues, communication, and leadership strategies ( Kumat-Thoma et al ., 2017). Similar results were observed in a study conducted amid nurses in Scotland, Northern Ireland, and England.
Operational Issues
Studies draw an interconnection amid power relations and job security and further delineate the ways in which these factors affect nurses’ morale. A qualitative research on U.S health care centers (n=29) aimed at assessing the impact of hospital financing and its effect on the nursing profession revealed that all nursing practitioners exhibited considerable anxiety due to job security regardless of their positions in the hospital hierarchy or the employment ( Kumat-Thoma et al ., 2017). In multiple instances, hospital administrators and nurses became polarized and resentful and this subsequently impacted their morale. The current U.S clinical practice often encourages low morale among health care givers especially in instances where cost efficacy is .paramount; this often leads to increased workload which, in turn, impacts their turnover rates. Disharmony often develops amid nurses in instances where a particular section of nurses are forced to work as both financial stewards and caregivers; this subsequently promotes poor morale amid nurses and the likelihood of resigning. The idea of minimizing costs and compromising health care is often increased by the need to restructure workforce models aimed at substituting cheap human resource or increasing the nurses’ workload.
Lippitt’s Change Theory
Lippitt extended the three-phase theory by Lewin and established a seven-phase theory which centers mainly on the responsibility and role of the change agent as opposed to the development of change itself. The seven phases by Lippitt include problem identification, the assessment of capacity and motivation for change, and the assessment of the change agent’s motivation and resources, and this incorporates the change agent’s commitment to the transition, stamina, and power ( Gilliam, 2015 ). Other phases include the selection of the progressive objects of change and this includes the establishment of strategies and plans of action, the selection of the change agent’s role, maintaining the change through aspects such as group coordination, communication, and communication, and terminating from the helping relation by gradually withdrawing the change agent.
Phase I (Diagnoses of the Problem)
High employee morale is crucial for an organization’s success ( Han, Trinkoff & Gurses, 2015 ). Employee morale often impacts productivity levels, employee turnover, employee’s attention to specific details, workplace safety, and the employee’s focus on patients, and, therefore, to attain the hospital’s goals and objectives, high morale among all employees is crucial. However, low employee morale has been identified among emergency room nurses who play one of the most important roles in the hospital. The hospital’s E.R nurses are often tasked with various duties which include, triage, taking the patients’ vital signs such as examining a patient’s blood pressure, temperature, and pulse rate, administering medicine, providing treatment, monitoring the patients’ progress, charting patients’ medical history, and patients’ discharge. There has been an increased level of absenteeism, conflicts amid the E.R nurses, patient complaints, uncooperative attitude, lack of enthusiasm, high turnover rates amid the E.R nurses, opposition to the department’s authority, and the lack of commitment among these nurses. These aspects, therefore, call for an increased need for change to enhance the hospital’s productivity and its overall performance. The organization will initiate a recruitment process to address the issue of understaffing, initiate a mandatory training session, adjust the organization’s policies, increase autonomy, and improve their working conditions by providing them with the required facilities and technologies.
Phase 2 (The Assessment of the Capacity and Motivation for Change)
The force-field analysis will be critical under this particular phase due to employee resistance to change ( Gilliam, 2015 ). With regards to the force-field analysis, I will first delineate the proposed plan for change to the healthcare workers under the E.R department. Secondly, I will identify the forces for change, low-employee morale. The E.R nurses’ low morale is highly attributed to understaffing, low professional worth, poor work relations among the nurses, the lack of autonomy, poor organization policies, lack of skill development, and poor working conditions. Thirdly, I will identify the forces against change such as the fear of the unknown, and the existing organizational structure. To effectively approach this step, I will employ the use of focus groups to communicate efficiently with the employees who might be impacted such as physician assistants, medical assistants, laboratory workers, and imaging technologists, address their concerns, and justify the change. To address the resisting forces, I will assign employees some level of control through the change process, clarify the need for change, and specify the time frame for the change.
Phase 3 (Change Agent)
The head of the nursing department will be designated as the change agent. The nurse manager is highly flexible, courageous, strategic, relational, and creative. The nurse manager also has a clear vision, knowledgeable and he often leads by example, he is patient yet persistent and is typified by effective communication skills.
Phase 4 (The Selection of the Progressive Objects of Change)
The implementation of the process will commence with the recruitment process to solve the issue of understaffing. The recruitment process will take approximately one and a half months. The human resource department will handle the entire recruitment process ( Gilliam, 2015 ). A job description which matches the duties of the E.R nurse will be prepared amid second October and fifth October. The job vacancy advert will then be posted on the company's internal and external websites, online job boards, social media platforms, and industry publications on sixth October. The company's recruitment system will be open for application postings for two weeks. The screening of applications using the recruitment system software will take three days (22nd to 24th October). Interview screening will then take place for two days (25th and 26th October). The interview process and the applicant talent evaluation will then run for five days (29th October to 2nd November). Background checks, the decision-making process, reference checks, and the dissemination of job offers will take place amid 5th November to 15th November. A week after terminating the recruitment process, the head of the E.R nursing department will submit up-to-date documentation detailing various aspects of the training program's needs to the H.R department. The H.R department will then assess the documentation and make the necessary arrangements to facilitate the training programs within a period of two weeks. Employee training will take place for approximately three months. The purchasing and inventory department will also be tasked with the duty of availing the required equipment within one month (5th October to 5th November); this will also facilitate the effectiveness of the training process. Six representatives from the E.R nursing department will also be selected by the nurse manager to represent the E.R nursing department throughout the entire change process. The reviewing of the hospital's organization policies will be effectively reviewed to ensure the useful inclusion of the ER nursing department for one month (5th November to 5th December). The hospital’s management team will do the reviewing process. The six E.R nurse representatives will be included in every part of the reviewing process.
Phase 5 (The Selection of the Change Agent’s role)
The change agent’s role provide coaching and training to other E.R nurses throughout the entire change process; this will help the E.R nurses to develop the skills and dispositions necessary to enhance the successful implementation of the change. The change agent will also mediate, and manage the change process. The change agent will take ownership of the readiness of the team, promote open communications within the team, discern and address potential sources of change resistance within the team, abide by the team’s quality standards, and lead by example.
Phase 6 (Maintaining Change)
During this stage, significant emphasis will be laid on aspects such as communication, motivation, teamwork, and employee feedback. The change agent will be required to utilize his interpersonal expertise to inspire change. He should strive to meet the employees’ intrinsic motivational needs because this will increase the employees’ job satisfaction rate, improve performance, and co-operation. The ongoing training will also be executed during this phase.
Phase 7 (Terminating the helping process)
The evaluation of the change process and the change agent’s withdrawal will take place in February 2019. The assessment of the change process will be done through patient satisfaction surveys and clinical audit.
Management Style
The change could be easily accomplished using the democratic management style. The democratic style of leadership incorporates the capacity of a leader to involve other members of the organization in various significant decision-making processes within the organization through promoting the group members’ interests and through fostering social equality within the organization. The democratic leadership encourages the distribution of responsibility, it empowers group members and encourages the aspect of inclusion during the decision-making process ( Collini, Guidroz & Perez, 2015 ). The democratic management style allows the effective direction of employees through suggestions and guidance. The democratic form of leadership creates job satisfaction among employees, and it encourages innovation strategies and creative solutions to various organizational problems.
Conclusion
Employee morale often impacts various aspects in an employees’ profession. Employee morale influences employee productivity, employee attitude, an employee’s daily decisions, workplace safety, punctuality and attendance, and relationships with management and co-workers. Factor's impacting an employees' morale within the workplace are usually classified as intrinsic and extrinsic. Intrinsic factors include work relationships, professional worth, patient care, and skill development. Extrinsic factors include organizational factors, staffing, operational issues, and leadership. There is an interconnection between the intrinsic and extrinsic factors. To effectively address these issues in the workplace, one may opt to initiate change within the organization. Lippitt change theory is a seven-phase theory centered on the responsibility and role of the change agent and the development of the change. The proposed change will be easily accomplished using the democratic management style because it encourages the distribution of responsibility, empowers group members, and encourages the aspect of inclusion which is critical during the decision-making process.
References
Collini, S., Guidroz, A & Perez, L. ( 2015 ). Turnover in health care: The mediating effects of employee engagement . Journal of Nursing Management , 23, 169 – 178. https://doi.org/10.1111/jonm.12109
Dotson, M. J., Cazier, J. A., Dave, D. S & Spaulding, T. J. (2014). An Empirical Analysis of Nurse Retention: What Keeps RNs in Nursing? The Journal of Nursing Administration, 44(2), 111-116.
Gilliam, D. A. (2015). Evaluation of Leadership Changes in Adult Primary Care . Retrieved from All Regis University Theses. (Paper 692)
Han, K., Trinkoff, A & Gurses, A. ( 2015 ). Work-related factors, job satisfaction and intent to leave the current job among United States nurses . Journal of Clinical Nursing , 24(21–22), 3224 – 3232 . https://doi.org/10.1111/jocn.12987
Kumat-Thoma, E., Ganger, M., Peterson, K & Channell, L. (2017). Reducing Annual Hospital and Registered Nurse Staff Turnover—A 10-Element Onboarding Program Intervention. Sage Journals, 3 . https://doi.org/10.1177/2377960817697712
Mazurenko, O., Gupte, G & Shan, G. (2015). Analyzing U.S. nurse turnover: Are nurses leaving their jobs or the profession itself? Journal of Hospital Administration , 4(4), 48-54. doi: https://doi.org/10.5430/jha.v4n4p48
