The study, which later served as the foundation for the grant, used Porter and Lawler’s (1968) work motivational theory to examine preferences of acute care AD or diploma RNs for organizational incentives and rewards that might motivate them to obtain a bachelor of science in nursing (BSN) or higher nursing degree. Although Porter and Lawler’s conceptual framework was comprehensive, it lacked social and psychological variables that may affect an individual’s motivation. These variables were added using the framework proposed by Sussman and Vecchio (1982) to include the concepts of organizational influences and individual characteristics (conceptual model of nursing motivation; Figure). The revised motivational model suggests that organizational incentives and rewards are mediated by individual characteristics (e.g., value, identity, and utility related). These characteristics influence the individual’s motivation to obtain an advanced degree and ultimately determine the final behavior of whether to enroll in an advanced nursing degree program. Perceived effort is defined as the influence of the rewards and incentives on motivating behaviors and reducing barriers. The behavioral intention is the action piece or, for the purpose of this study, the decision by the individual to return to school for a BSN or higher nursing degree.
Figure: Conceptual Model of Nursing Motivation.
A descriptive, cross-sectional study was performed in Maryland. Permission to use human subjects was obtained through a university Institutional Review Board. Using Aday’s (1996) sampling formula for a cross-sectional (one group) design, with a desired level of precision of 0.05 and assuming a 95% confidence interval, a sample size of 384 was needed. This sample size was also deemed adequate to perform the planned data analyses. Using data from a pilot study, the number of surveys mailed was increased to 1,800 due to issues with inaccuracies within the selected database and a higher than expected non-response rate.
A survey was conducted that included actively licensed AD or diploma nurses in Maryland who were younger than 50 years, working 20 hours or more per week in an acute care hospital, and not currently enrolled in a BSN or higher nursing degree program. Names were randomly selected from the Maryland Board of Nursing (MBON) licensure database. Three mailings, approximately 3 weeks apart, were sent during May and June 2004. Of 1,800 surveys mailed, 552 (31%) responses were received; of these, 297 respondents (54%) were eligible for the study. Of the 255 respondents not included in this analysis, 241 did not meet the eligibility criteria, 9 elected not to participate (returned signed survey with no eligibility criteria data completed to make an assessment), and 5 completed the entire survey but skipped the eligibility criteria. Although the MBON database contained demographics (e.g., education, age, workplace, and setting) and licensure information on all actively licensed RNs working in Maryland, some coverage and sampling error existed with this database. Self-reported data are submitted by nurses at the time of licensure or annually with renewal. Updating demographics is not required for licensure. Demographics are presented in Table 1. When compared with the data from the 2004 National Sample Survey of RNs, respondents between 40 and 50 years old were overrepresented (Human Resources and Services Administration, 2004).
Table 1: Demographics of the Respondents Versus Registered Nurses Nationally
Four scales were developed to examine the perceived importance of organizational rewards and incentives in influencing nurses to return for an additional nursing degree. Organizational rewards were defined as favorable outcomes nurses would receive from the organization if they completed a BSN or higher nursing degree. Organizational incentives were items that might reduce barriers or perceived difficulties to returning to school. A list of 10 organizational rewards and 10 incentives was developed from the literature and interviews with nursing leaders.
Variables pertaining to nurses’ individual characteristics, such as professional commitment, career satisfaction, perceived value of a BSN degree, work-family conflict or family-work conflict, barriers to receiving a BSN degree, and demographics, were measured. Professional commitment was measured using a modified version of the shortened organizational commitment survey (Mowday, Steers, & Porter, 1979). The modified instrument replaces the word organization with profession for each item (Vandenberg & Scarpello, 1994). Items were anchored using a 7-point Likert scale (strongly agree to strongly disagree). Internal consistency coefficients reported in the literature for this modified professional commitment scale were 0.73 and 0.70 for two time measures (Vandenberg & Scarpello). For this study, Cronbach’s alpha (0.88) was higher, indicating good internal consistency.
The next measure was the “career satisfaction” scale by Greenhaus, Parasuraman, and Wormley (1990). Items were anchored using a 5-point Likert scale (strongly agree to strongly disagree). Evidence of internal reliability from the literature ranged from 0.83 to 0.89 (Aryee, Chay, & Tan, 1994; Greenhaus et al.), which was similar to Cronbach’s alpha of 0.90 in the current study. The descriptive statistics suggested that the majority of respondents were satisfied with their career (M = 1.88, SD = 0.95), but were less satisfied with income (M = 2.20, SD = 1.14) and goals for advancement (M = 2.24, SD = 1.02).
Characteristics differentiating between the roles of a BSN and an AD or diploma nurse, identified from the literature and by an expert panel, were used to construct a scale to measure the attractiveness and desirability of the BSN role (American Association of Colleges of Nursing, American Organization of Nurse Executives, & National Organization for Associate Degree Nursing, 1995; Goode et al., 2001). A two-factor solution accounting for 64% of the inter-item variance with a Cronbach’s alpha of 0.75 was found. The first factor reflected items surrounding the belief system of the role of the BSN nurse. The second factor was reflective of greater opportunities a BSN nurse might have in the work environment.
The 10-item “work-family and family-work conflict” scale by Netemeyer, Boles, and McMurrian (1996) was used to measure participants’ perceptions of role conflicts and hence their ability to return for a BSN or higher nursing degree. Work-family conflict was defined as the inter-role conflict created by the job’s interfering with performing family-related responsibilities. To the contrary, family-work conflict is created when family interferes with work-related responsibilities. For this study, Cronbach’s alpha for the entire instrument was 0.90 (0.92 for the work-family conflict subscale and 0.90 for the family-work conflict subscale). Respondents reported greater work-family conflict than family-work conflict.
An 8-item list using a 7-point scale (not at all to a very great extent) to assess perceived barriers to returning for an additional nursing degree was developed from several sources (Heller & Sweeney, 2003; Maryland Colleagues in Caring: Regional Collaboratives for Nursing Work-force Development, 2002). An exploratory factor analysis derived a two-factor solution accounting for 69% of the variance using 5 items. The first factor reflected “competing priorities,” a major theme identified by Delaney and Piscopo (2004). Items included time investment, ability to balance school, work, and family, and ability to match work and school hours. The second factor consisted of cost of tuition and family responsibility. These variables appeared to reflect external constraints as barriers.
The dependent variable was defined as the behavioral intent to return for an additional nursing degree if the right combination of rewards and incentives was offered. Behavioral intent was measured by asking participants a series of questions to determine their readiness to pursue a BSN or higher nursing degree. The primary outcome variable was a simple yes or no question regarding the likelihood of returning to school if the right combination of rewards and incentives was offered. In addition, intent was explored by asking participants about when they might return for a degree, their ability to be successful in a BSN or higher nursing degree program, their financial willingness, and the perceived importance of receiving a degree.