Identifying the Organizational Factors Influencing Academic Motivation Among Midwives and Nurses in Ethiopia: A Multicenter Cross-Sectional Analysis

Abstract

Introduction

Motivation in work settings is defined as the willingness to exert and maintain effort toward organizational goals. Midwifery and nursing professions are among the most stressful of all the healthcare practices in the global healthcare system. The tools used to measure the organizational factors of the academic motivation of healthcare providers include working conditions and facilities, job roles and responsibilities, work-related health and safety, incentives other than salary, resource availability, and supervision. Despite their vital role in the quality of healthcare, developing countries lack evidence on the organizational factors affecting the motivation of midwives and nurses.

Objective

To determine the organizational factors of academic motivation among midwives and nurses in Ethiopia

Methods

An institution-based cross-sectional study was employed. This study was conducted at teaching hospitals located in the Amhara regional state. The academic motivation of midwives and nurses was assessed via interviews. For the analysis, SPSS version 23 was utilized after the data were entered using epi data. Following data collection, the data were examined for internal consistency and completeness. A quota sampling technique was carried out for all midwives and nurses in the study until the required number of participants was reached. A pretest using 5% of the sample size was conducted.

Results

The prevalence of organizational academic motivation among nurses and midwives in teaching hospitals in the Amhara regional state was 27.34% (confidence interval: 21.76%–33.85%). Satisfaction with the general working environment, satisfaction with being safe from disease in the workplace, having a good competitive salary, and satisfaction with the future pension plan of the government were positively associated with organizational academic motivation.

Conclusions

Organizational factors are strongly associated with the academic motivation of nurses and midwives. Every stakeholder of the healthcare system should strive to solve the organizational factors of academic motivation.

Keywords

academic motivation Ethiopia organizational factors midwives nurses

Introduction

Motivation in work settings is defined as the willingness to exert and maintain effort toward organizational goals (Fernandes et al., 2022; Malik et al., 2018). Motivation is a critical aspect to consider for the achievement of any kind of health service target or reform (Malik et al., 2018; Okello, 2014). Largely, motivation is considered the driving force for pursuing and satisfying needs, whereas job satisfaction is an emotional response to job conditions. Motivation and job satisfaction are distinct constructs but are known to be highly related, are often used interchangeably (Malik et al., 2018; Mamah & Ogbu, 2015), and are highly interdependent in increasing job performance in healthcare settings (Dieleman et al., 2003).

Organizational academic motivation is related to interests and spontaneous satisfaction and relates to different activities with separable outcomes or consequences (Makhamreh et al., 2022; Purohit et al., 2016; Willis-Shattuck et al., 2008). Compassion has both emotional and behavioral elements and can be seen as a process that starts with the recognition of others’ suffering and incorporates behavior aimed at alleviating that suffering (Ménage et al., 2017; Seery).

Review of Literature

Midwifery and nursing professions are among the most stressful of all the healthcare practices in the global healthcare system (Bakibinga et al., 2012; Sabzevari & Rad, 2019). The importance of staff well-being in healthcare is a prominent feature in maternity care policy documents and guidelines, both in Ireland and internationally (Burton, 2010; Doherty & O’Brien, 2022; Helps et al., 2021). The provision of emotional, physical, spiritual, and psychological presence/support by a midwife, as desired by the laboring woman, is dependent on the healthcare provider's (HCP’s) motivation (Newton et al., 2014).

The quality of care in the modern healthcare system of developing countries, including Ethiopia, is dependent on the level of passion and motivation of midwives in maternity wards and nurses in medical, surgical, and emergency wards (Carolan & Kruger, 2011; Crowther et al., 2016). Nurses in sub-Saharan Africa play a major role in primary healthcare delivery, especially in areas where other healthcare cadres are scarce (Bakibinga et al., 2012; Engelbrecht, 2005). Nursing and midwifery practices everywhere are acknowledged as stressful, and nurses in Africa bear especially significant burdens due to very poor pay and heavy workloads. This exposes them to stress and burnout (Bakibinga et al., 2012).

The tools used to measure the organizational factors of the academic motivation of HCPs include working conditions and facilities, job roles and responsibilities, work-related health and safety, incentives other than salary, resource availability, and supervision (Malik et al., 2018).

Moreover, the morale of the staff tends to improve when they are properly motivated (Bakibinga et al., 2012).

Problem Statement and Objectives

Studying job satisfaction is both intriguing and vital, as it has a wide range of positive effects on employees, organizations, and society as a whole (Aroosiya et al., 2021). Additionally, this leads to maximizing output in the industrial sector while also promoting greater human value within the workplace (McCall et al., 2009).

This study seeks to address this gap by analyzing key workplace determinants. Although academic motivation is crucial for the quality of healthcare services, there is a lack of evidence in developing countries regarding the organizational factors that influence the motivation of midwives and nurses. Therefore, this study investigates the various organizational factors that affect the academic motivation of midwives and nurses in teaching hospitals in the Amhara region of Ethiopia. The findings are expected to provide valuable insights for healthcare policymakers in the country to improve healthcare delivery models. Furthermore, the study would be the cornerstone for further analysis of organizational factors of academic and professional motivations.

This study aimed to determine the organizational factors affecting academic motivation among midwives and nurses in teaching hospitals in the Amhara regional state.

Methods and Procedures

Study Design and Setting

This multicenter, institution-based cross-sectional study was carried out in four major teaching hospitals across the Amhara Regional State, namely the University of Gondar Hospital, Tibebe Ghion Referral Hospital, Dessie Referral Teaching Hospital, and Debre Birhan Referral Hospital. All the study settings are teaching referral hospitals in Ethiopia, which are primarily serving the population of the Amhara regional state. Those study settings were selected randomly among all government teaching hospitals in Amhara regional state. It was conducted from 1 January 2024 to 15 March 2024. All the hospitals had midwives and nursing professionals.

Source Population

All nurses and midwives working at selected teaching hospitals in the Amhara regional state, Ethiopia

Study Population

All selected nurses and midwives working at selected teaching hospitals in the Amhara regional state, Ethiopia, during the study period till the required sample was achieved.

Sample Size Determination and Sampling Technique

The sample size was determined with a 50% proportion (p = 0.5; the level of significance of the population was taken to be 95%, Z α/2 = 1.96). A 5% level of precision (d = 0.05). Ultimately, the sample size included was 384. A quota sampling technique was carried out for all midwives and nurses in the study until the required number of participants was reached.

Data Collection and Analysis Procedures

The data were collected by eight BSc midwives who had received three days of training. The necessary data were gathered via a structured questionnaire from previously published works (Al Ansari et al., 2021). The academic motivation of midwives and nurses was assessed via face-to-face interviews using structured tools. The academic motivation of midwives and nurses was measured using a structured 12-item tool. For the analysis, SPSS version 23 was utilized after the data were entered using epi data. The validity and reliability of the tools were determined in a procedural way with expert consultation and a literature review. Following data collection, the data were examined for internal consistency and completeness before being subjected to descriptive statistical analysis. To assess the relationship between dependent and outcome variables, bivariate and multivariate analyses yielded crude odds ratios (CORs) and adjusted odds ratios (AORs), with 95% confidence intervals (95% CI). The Hosmer–Lemeshow goodness-of-fit test and multicollinearity were examined to reduce bias and determine the fitness of the model.

Inclusion criteria. All licensed nurses and midwives working at the teaching hospitals in Amhara regional state were included in the study.

Exclusion criteria. Midwives and nurses who were not available at work during data collection because of long periods of leave, including sick leaves, education leaves, maternity leaves, and annual leaves.

Outcome measures. The primary outcome of this study was the determination of the organizational factors of academic motivation among nurses and midwives working at teaching hospitals in the Amhara regional state. It was measured using structure tools containing the lists of organizational factors through it.

Quality Control Measures

A pretest using 5% of the sample size was conducted, and the data gathering tool was then revised. In addition, the entire process of gathering data was overseen.

Operational Definitions

Intrinsic factor of motivation. The motivation to engage in a behavior is because of the inherent satisfaction of the activity rather than the desire for a reward or specific outcome (Malik et al., 2018).

Academic motivation. The cause of behaviors that are related to academic functioning and success (Hoa et al., 2020; Malik et al., 2018).

Organizational factors of motivation. The motivation to engage in a behavior is because of the reward system of the organization, leadership style, organizational climate, incentives, and structure of the work (Malik et al., 2018; Newton et al., 2014).

Motivated. When a midwife/nurse answered “yes” to the organizational factor questions above, the mean score, he/she was deemed to have academic motivation. If not, he/she was regarded as not having an academic motivation (Fernandes et al., 2022; Malik et al., 2018).

Results

A total of 384 respondents were included in this study, for a response rate of 100%. The majority of the respondents in the study were found in the age group of between 25 and 34 years, were orthodox Christians in religion, and had a monthly income of >6,000 ETB (Table 1).

Table 1.

Distribution of the Sociodemographic Characteristics of the Respondents at Teaching Hospitals in the Amhara Regional State, Northwestern Ethiopia, 2024 (N = 384).

Characteristics	Number	Percent
Age group
18–24	131	34.11
25–34	184	47.92
≥35	69	17.7
Educational status
First degree	343	89.32
Second degree	41	10.68
Monthly income (ETB)
≤6,000	103	26.82
>6,000	281	73.18
Marital status
Married	299	77.86
Not married	85	22.14
Religion
Orthodox	248	73.96
Muslim	96	25.26
Protestant	40	10.68

Note. ETB = Ethiopian Birr.

The majority of the respondents did not have proper dressing rooms or toilets in their organization, were not satisfied with the general work environment, did not have a good competitive salary for this profession, and were not satisfied with opportunities for promotion (Table 2).

Table 2.

Distribution of the Academic Motivation Organization Factors of the Respondents at Teaching Hospitals in the Amhara Regional State, Northwest Ethiopia, 2024 (N = 384).

Organizational Factor		Number	Percent
Working conditions and facilities
Availability of proper dressing rooms	Yes	69	17.97
Availability of proper dressing rooms	No	315	82.03
Availability of proper toilets	Yes	23	5.99
Availability of proper toilets	No	361	94.01
Availability of an appropriate environment for treating patients	Yes	112	29.17
	No	272	70.83
Availability of proper ventilation in the workplace	Yes	245	63.80
Availability of proper ventilation in the workplace	No	139	36.20
Satisfaction with the general work environment	Yes	126	32.81
Satisfaction with the general work environment	No	258	67.19
Job roles and responsibilities
Satisfaction with the clarity of my job description	Interested	243	63.28
Satisfaction with the clarity of my job description	Not interested	141	36.72
Satisfaction with referral procedures	Yes	254	66.15
Satisfaction with referral procedures	No	130	33.85
Satisfaction with work according to my job description	Yes	199	51.82
Satisfaction with work according to my job description	No	185	48.18
Work-related health and safety
Satisfaction with safety during work from diseases	Yes	121	35.51
Satisfaction with safety during work from diseases	No	263	68.49
Satisfaction with personal safety and security measures at work	Yes	176	45.83
	No	208	54.17
Satisfaction with occupational health and safety measures in general at work	Yes	196	51.04
	No	188	48.96
Pay
Good competitive salary for this profession	Yes	87	22.66
Good competitive salary for this profession	No	297	77.34
Income is in accordance with my education, skills, performance, and knowledge	Yes	72	18.75
	No	312	81.25
Salary is enough to fulfill my and my family's basic needs	Yes	50	53.02
Salary is enough to fulfill my and my family's basic needs	No	334	86.98
Satisfaction with salary increments	Yes	64	16.67
Satisfaction with salary increments	No	320	83.33
Incentives other than salary
Satisfaction with pension plan	Yes	69	17.97
Satisfaction with pension plan	No	315	82.03
Satisfaction with opportunities for higher qualifications	Yes	96	25
Satisfaction with opportunities for higher qualifications	No	288	75
Satisfaction with opportunities for promotion	Yes	73	19.01
Satisfaction with opportunities for promotion	No	311	80.99
Satisfaction with insurance plan	Yes	85	22.14
Satisfaction with insurance plan	No	299	77.86
Resource availability
Satisfaction with supplies available at work	Yes	139	36.20
Satisfaction with supplies available at work	No	245	63.80
Satisfaction with equipment available at work	Yes	203	52.86
Satisfaction with equipment available at work	Yes	181	47.14
Satisfaction with drugs available at work	Satisfactory	134	34.90
Satisfaction with drugs available at work	Nonsatisfactory	250	61.10
Satisfaction with the appropriate number of staff available at work	Good	225	58.59
	Bad	159	41.41
Supervision
Satisfaction with feedback received from my supervisor	Yes	109	28.38
Satisfaction with feedback received from my supervisor	No	275	71.62
Satisfaction with the quality of supervision received	Yes	111	28.91
Satisfaction with the quality of supervision received	No	273	71.09

Multivariate logistic regression revealed that the following organizational factors determined academic motivation: satisfaction with the general working environment, good competitive salary for the profession, satisfaction with safety from disease during work, and satisfaction with the pension plan (Table 3).

Table 3.

Multivariate Logistic Regression of Organizational Factors Associated with Academic Motivation in Teaching Hospitals in the Amhara Regional State, Ethiopia, in 2024 (N = 384).

Variables		Academic Motivation
Variables		Yes (n = 105)Number (%)	No (n = 279)Number (%)	COR (CI)	AOR (CI)
Availability of a proper toilet	Yes	08	15	1.61 (1.02–4.91)	1.29 (0.07–3.21)
Availability of a proper toilet	No	90	271	Ref	Ref
Satisfaction with the general working environment	Satisfied	60	66	4.95 (2.32–6.17)	3.17 (1.73–5.02**)
Satisfaction with the general working environment	Not satisfied	40	218	Ref	Ref
Satisfaction with safety from disease during work	Satisfied	71	50	2.97 (1.89–4.04)	1.74 (1.03–4.29)*
Satisfaction with safety from disease during work	Not satisfied	85	178	Ref	Ref
Good competitive salary for the profession	Yes	43	44	3.17 (2.72–5.31)	2.49 (1.18–4.05)***
Good competitive salary for the profession	No	70	227	Ref	Ref
Satisfaction with pension plan	Satisfied	30	39	3.41 (1.57–5.21)	2.92 (1.11–3.98)**
Satisfaction with pension plan	Not satisfied	58	257	Ref	Ref
Satisfaction with opportunities for higher qualifications	Satisfied	42	54	3.08 (2.61–6.03)	2.36 (0.91–3.76)
Satisfaction with opportunities for higher qualifications	Not satisfied	58	230	Ref	Ref
Satisfaction with the quality of supervision	Satisfied	41	70	2.27 (1.09–5.18)	1.85 (0.62–3.08)
Satisfaction with the quality of supervision	Not satisfied	56	217	Ref	Ref

Note. COR = crude odds ratio; AOR = adjusted odds ratio; CI = confidence interval. *p < 0.05; **p ≤ 0.01; ***p ≤ 0.001.

Discussion

Main Finding

The main finding of this study was the determination of the organizational factors of academic motivation among nurses and midwives working at teaching hospitals in the Amhara regional state. The overall prevalence of organizational academic motivation among nurses and midwives in teaching hospitals in the Amhara regional state was 27.34% (CI 21.76%–33.85%). This finding is lower than that of a study performed among HCPs in public hospitals (Dagne et al., 2015; Mamah & Ogbu, 2015). The reason for this discrepancy could be the difference in the study setting and the current limitation of government incentives for HCPs, which does not even cover the basic need for market inflation in Ethiopia. In addition, the infrastructure of the healthcare settings and the opportunities given for midwives and nurses do not benefit them, as priority is given only to the clients in the healthcare system of Ethiopia. Despite the discrepancy in prevalence, the findings of this study are an alarming sign for government and healthcare system policy makers to reform the organizational factors of academic motivation among nurses and midwives in the healthcare system of Ethiopia. This would again benefit the quality of healthcare in the healthcare setting of Ethiopia.

Interpretation for Working Condition Factors

In this study, the odds of academic motivation were 3.17 times greater among nurses and midwives who were satisfied with their general working environment (AOR = 3.17 (1.73–5.02)) than among those who were unsatisfied. Despite the limitations of studies on organizational academic motivation, the available literature supports this finding (Malik et al., 2018; Willis-Shattuck et al., 2008). The possible justification for this association could be the need to have intrinsic intention and satisfaction in the general healthcare system for a midwife and/or nurse to have academic energy to perform their responsibilities. This might include satisfaction with colleagues, clients, supervisors, the infrastructure, and managerial-level persons.

The study also reported that being satisfied with the measure of safety from disease during work (AOR = 1.74 (1.03–4.29)) increased the odds of academic motivation by 74% compared with being dissatisfied. There is literature that is in line with this association of the independent variable with the academic motivation of midwives and nurses (Okello, 2014; Tanaka & Watanabea, 2012). The possible reason for this association could be that HCPs are prone to any form of hospital-acquired disease unless primary protection mechanisms are formulated and given to them. Hence, when midwives and nurses are afraid of these communicable diseases, they fear their families and themselves. This again affected their organizational academic motivation in the workplace. The nature of the healthcare services provided by nurses and midwives in the healthcare system of Ethiopia exposes them to vulnerabilities, leading to disease. Working for humans with a disease is frustrating unless precaution is taken. This affected the academic motivation of HCPs.

Interpretation for Compensation Factor

A good competitive salary for midwives and nurses (AOR = 2.49 (1.18–4.05)) also increases the academic motivation of nurses and midwives by 2.49 times compared with those who lack a good competitive salary. Studies of health professionals’ job satisfaction and academic motivation supported this finding (Engelbrecht, 2005; Newton et al., 2014). The possible reason for this association could be that the primary intention of any government employee is to support him/herself and his/her family with the incentives he/she receive. However, having a salary that is not competitive with current global and national market inflation does not even fulfill basic needs. This will again reduce the academic motivation of midwives and nurses in their workplace. If an employee believes that his or her salary is below his or her academic preparation, he or she would plan to leave the organization rather than stay there. This is basically due to the reduction in the organizational academic motivation of employees.

This study also revealed that being satisfied with the future pension plan of the government (AOR = 2.92 (1.11–3.98)) increases the odds of organizational academic motivation being 2.92 times greater for nurses and midwives than for those who are dissatisfied. The possible reason for this relationship could be the inadequacy of the current salary and related incentives for the midwives and nurses to reserve for their older age (Malik et al., 2018). Once they are out of the profession, they cannot even have a house and related basic needs for their families. Therefore, they rely on the future pension plan of the government. Hence, if the future pension plan of the healthcare system is unsatisfactory, HCPs would not have organizational academic motivation.

Strengths and Limitations of the Study

The study's strengths include its specific focus on determining the organizational factors of academic motivation among nurses and midwives. The multicenter study allows generalizability, and its organizational focus offers actionable insights among understudied professional groups.

The main limitation of this research is that the cross-sectional nature limits causality and the limited control over confounding variables.

Implication for Practice

This study suggested that improved human resource policies in healthcare institutions, targeted professional development initiatives, informed organizational leadership, informed national health policy and workforce planning, and strengthened health system capacity for improved organizational academic motivation among midwives and nurses.

Conclusion

The prevalence of organizational academic motivation among nurses and midwives in teaching hospitals in the Amhara regional state was 27.34% CI (21.76%–33.85%). Satisfaction with the general working environment, being safe from disease in the workplace, and a good competitive salary were the factors associated with organizational academic motivation among midwives and nurses. The study findings showed genuine implications of organizational factors for health professionals' academic motivation.

Therefore, stakeholders should work on the organizational needs of HCPs to improve the organizational academic motivation of midwives and nurses in the modern healthcare system of the country. In addition, the study implies that for the implementation of a health worker motivation strategy, invest in infrastructure and improve supervision protocols. The study also recommends that future researchers study the detailed association between academic motivation and the intrinsic factors of employees beyond the organization.

Footnotes

Acknowledgments

We are grateful to the data collectors, midwives, and nurses who participated in the data collection, hospital managers, health professionals, and all individuals who were willing to support us to any extent.

ORCID iDs

Besfat Berihun Erega

Wassie Yazie Ferede

Begizew Yimenu Mekuriaw

Ethical Approval and Consent to Participate

Ethics approval was obtained from the College Health Science Ethical Review Board of Debre Tabor University with reference number DTU/0061/24. Written informed consent was obtained from all participants and the health providers who participated in the study. Names and other identifying information were not included in the study. In addition, all methods were performed in accordance with the relevant guidelines, regulations, and the study adhered to the Declaration of Helsinki.

Author Contributions

Besfat Berihun Erega is the corresponding author and participated in design, investigation, resource, supervision, methodology, writing, reviewing, analysis, data entry, and revision. Yirgalem Abere Ayenew is a coauthor and involved in design, resource, supervision, methodology, writing, reviewing, analysis, data entry, and revision. Rahel Birhanu Arage is a coauthor and involved in design, investigation, supervision, methodology, writing, reviewing, analysis, data entry, and revision. Habtam Dessie Alemayehu, Wassie Yazie Ferede, Begizew Yimenu Mekuriaw, Dagne Addisu, and Eyob Shitie Lake are coauthors and involved in design, investigation, resource, supervision, methodology, writing, reviewing, analysis, data entry, and revision.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Availability of Data and Materials

All data included in this manuscript can be accessed from the corresponding author upon request through the email address.

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