Nurses' Commitment and Motivation to Improved Personal Health: The Role of Hospital Administration

Purpose:  

     As nurses comprise the largest sect of the healthcare industry, their health affects the overall effectiveness of health systems. Nurses are highly educated, yet, for many there is a disconnect between knowledge and the status of their physical health. Thus, it is important to investigate what could motivate nurses to improve their health, particularly in three major facets: decrease BMI, increase physical exercise and eat healthier. The purpose of the research is to ascertain the most effective interventions that employers could institute to motivate nurses to increase their physical health. Currently, there is a drastic lack of knowledge related to how nurses are motivated. This research will bridge the gap between intrinsic motivation and extrinsic interventions.

Methods:

     The study was a mixed design, containing both quantitative and qualitative data. Subjects read and signed a consent form, then completed a demographics questionnaire.  Specific questions on the demographics sheet included: how much physical exercise they participate in, if weight loss was a goal for them and if they believed that their diet was healthy. The 139 participants were all nurses and lived in the Northwest region of the United States at participating facilities.

     Subjects were given a case study generated by the researcher. The case study involved Nurse X and how Nurse X had gained weight and had become less active. Nurse X subsequently decided that she/he wanted to improve their health status. The participants were asked to transpose themselves as Nurse X and rate (on a Likert Scale) which of the given scenarios would best motivate and gain their commitment to increase their health status. The scenarios ranged from employers offering more healthy food choices to reductions in health insurance premiums for improved health.

     Furthermore, the subjects also responded to the following three open-ended questions: 1) name three factors that have impeded you from obtaining your optimal health, 2) describe three interventions that employers could provide to help you improve your health, 3) what additional thoughts do you have about achieving optimal health.

     A partition was set up to guarantee the anonymity of the subjects taking the survey. Next to the partition were two sealed drop boxes; one for the signed consent forms and one for the subject’s surveys; materials were set up in break-rooms. There was no direct participant contact. The survey and demographics tool were used in a pilot study to test the validity and the accuracy of the tool.

Results:

            Data presented represents results from 139 surveys collected over a five month time period. The majority of subjects were female (84.0%). For 53.9% of the respondents, weight loss was a goal. The majority (78.4%) responded that their diet was healthy and nutritious. Quantitative data is displayed in Table 1.

Table 1. Kruskal-Wallis non-parametric statistical test

Intervention	Response to intervention		H Value		Degrees of Freedom		Number	Probability		Mean Ranks
										Overweight	Obese	Normal
Facility offering healthier food choices	Motivation		H= 7.72		df= 2		136	P= 0.0211*		58.0	87.1	70.3
	Commitment		H= 4.22		df= 2		137	P= 0.1212		65.0	85.3	66.7
Onsite workout facilities	Motivation		H= 5.35		df= 2		137	P= 0.0689		60.2	84.6	69.7
	Commitment		H= 0.80		df= 2		137	P= 0.6703		64.8	68.5	71.6
Group weight loss program	Motivation		H= 25.95		df= 2		137	P=0.0001*		63.8	109.5	60.5
	Commitment		H= 25.59		df= 2		137	P< 0.0001*		62.7	109.3	61.2
Decreased health insurance premiums	Motivation		H=29.23		df= 2		137	P< 0.0001*		80.6	101.0	53.0
	Commitment		H= 19.97		df= 2		137	P< 0.0001*		74.1	99.9	57.1
Cash for losing percentage of body fat	Motivation		H= 1.37		df= 2		137	P= 0.5143		74.6	68.8	65.8
	Commitment		H= 1.42		df= 2		137	P= 0.4916		74.1	71.4	65.3
Paid an hourly wage to work out	Motivation		H= .57		df= 2		133	P= 0.7520		70.2	68.8	64.7
	Commitment		H= .49		df= 2		133	P= 0.7827		69.9	68.7	64.9

Note. H Value = The Kruskal-Wallis Test. P-value of 0.05 or less was selected as statistically significant, depicted using an asterisk (*).

Six qualitative themes emerged in response to the open-ended questions:

• Theme I: Lack of Time -- Nurses described a lack of time both on the job and at home as barriers to their optimal physical health status. Examples of this included: “There are only 24 hours in a day and I already have too much on my plate.” “I cannot even find time in the day to use the bathroom, let alone take a break. I am still on orientation, so I hope it doesn’t last too much longer like this or I will die.” This poignant depiction of this nurse schedule was mirrored by several other subjects.

• Theme II: Twelve Hour Work Schedules and Lack of Breaks Affect the Quality of Life -- Thirty-eight percent of subjects described the twelve hour shifts as barriers to their optimal health in addition to the issues with contractual break allowances. Nurses overwhelmingly described that breaks were not restful, but, in fact were just an opportunity to catch up on tasks. The dichotomy between patient safety and the health of the nurse was a common thread woven into this theme.

 

• Theme III: Physical Demands of Nursing -- Respondents described the emotional and physical demands of the nursing profession. Examples of this included: “I give everything to my patients, by the time that I can go home, I am mentally and physically drained.” Subjects also described physical pain caused by nursing.

• Theme IV: Lack of a Supportive Work Environment -- Forty-two percent of nurses commented on what they believed was both a lack of support from their employer as well as employer created obstacles to optimal health. “Hospitals in general only care about the bottom line, they do not see the benefit of prevention.” Nurses reported the hypocrisy of teaching patients about prevention and health promotion when the institution that they work for does not champion or sponsor employee health.

• Theme V: Personal Accountability -- Subjects acknowledged their own roles in obtaining and maintaining optimal health. Respondents described either not caring about health, committing sabotaging behaviors, or poor self-control. Nurses used eating to mitigate hard days at work, “I comfort myself with food.” An obese nurse responded that, “I am apathetic to being a bit overweight.”

• Theme VI: Being Overweight is a Benefit to the Nursing Profession -- Qualitative findings were segmented into three groups as a function of BMI (normal, overweight and obese). No significant qualitative differences were found between the overweight and the normal weight groups. However, responses from the obese group were thematically distinctive. Several nurses within the obese category responded that being overweight helped them to be better nurses, “my weight doesn’t affect my nursing, I am healthy,” and the idea that, “if I did not have some extra weight, I could never do this job.” In addition to nurses feeling that being overweight did not interfere with their ability to deliver effective patient care, several respondents noted that they felt as if being obese was important for communication and the nursing process. One indicated that, “I think that having a few extra pounds makes me more approachable than the ‘skinny nurses’.” Commonly, nurses explained that being overweight was a bonus and almost a necessity to provide exceptional nursing care. A morbidly obese nurse responded that, “My weight doesn’t affect my nursing, I am healthy.” 24.0% of the respondents in the obese category responded that they believed they were healthy.

Conclusion:

     If an employer was to institute a health promotion intervention, this research would help to guide them to design the most effective strategies. The two ways that this study could guide an administration are to supply the most effective intervention as indicated by self-reported levels of commitment and motivation as well as to help employers focus their attention on a specific weight group (i.e. overweight). The most effective interventions for all three weight groups were related to financial incentives; this included a decrease in insurance premiums, a cash incentive for a percentage of weight loss as well as paid time to work out. This is believed to be related to the financial incentive related to each and the tangible reward for a health improvement.

     This research suggests that employers should emphasize resources on the overweight group who were the most motivated and committed towards the interventions proposed. The obese group was the least motivated and less committed towards improving their health. The obese group was the only group to respond to the research materials using profanity and expletives. The obese group also reported that they were believed themselves to be healthy. It is suspected that this was attributed to the frustration related to their body weight. Some subjects responded with a tone of helplessness and futility. With the upcoming nursing shortages and healthcare being dramatically remodeled in the United States, supporting nurses’ health becomes paramount. Patients look to nurses for information on health promotion and disease prevention. If a nurse is obese, the nurse loses credibility and reliability. Employers, patients and nurses can all benefit from improving nurses’ health.