The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.

org

Incentives System for Nurses in Assiut University Hospital

Ekram M. Abdel Khalek1* • Hala R. Yousef 2 • Doaa’ M. Ahmed3

1
Assistant Professor of Public Health & Community Medicine, Faculty of Medicine, Assiut University, Egypt
2
Professor of Nursing Administration, Faculty of Nursing, Assiut University, Egypt
3
Nursing supervisor in Infection Control Unit, Assiut University Hospital, Egypt
[email protected]

ABSTRACT
Background: Incentives play an important role in organizations as it influences a variety of work-related behavior,
as well as the motivation of employees. Aims of the study: The present study was conducted in the main Assiut
University Hospital to assess nurse’s awareness and satisfaction regarding the incentives system. Subjects and
Methods: This study included 271 nurses who randomly selected from all units at the main Assiut University Hospital.
The study included both quantitative and qualitative methods for data collection. Results: High percent of the
participants reported that the most important incentives are fair remuneration, bounces, appropriate working hours,
and different services (health/ education) (69.7%, 60.9%, 60.5, % 60.5%, respectively). The promotion, appreciation
of work efforts, good relations with colleagues and superior encouragement were the most important morale incentives
reported by (77.1 %, 71.2 %, 66.8 %, 64.6%) respectively. This is confirmed by the results of Focus group discussions
as about half of the participants especially female nurses considered the morale incentives are more important than
the financial one especially the good dealing and the respect from the physicians. Conclusion and
Recommendations: In conclusion, this study indicates that nurses know what they want from incentives. Attention
to priorities and flexible incentives system may help to create the cohesive work environment that nurses seek.
Determine the objectives are the most important factors to increase the effectiveness of the incentive system.

To cite this article

[Abdel Khalek, E. M., Yousef, H. R., & Ahmed, D. M. (2016).Incentives System for Nurses in Assiut University
Hospital. J. Middle East North Afr. sci, 2(3), 61-69]. (P-ISSN 2412- 9763) - (e-ISSN 2412-8937).
http://www.jomenas.org. 8

Keywords: Incentives; Nurses; Assiut University Hospital; Incentives System.

1. Introduction include work autonomy, flexible hours, and

Incentives play an important role in scheduling, coaching and mentoring structures,
organizations as it influences a variety of work-related support for career development, safe and clear
behavior, as well as the motivation of employees. workplaces, vacation days, study leave, planned
Also, it can use to guide behavior and performance in career breaks, occupational health and counseling
an attempt to attract and retain the best-qualified services, recreational facilities, equal opportunity
employees and keep them satisfied and motivated policy, enforced protection of pregnant women
(Gieter et al., 2006). Incentives defined as “all the against discrimination & parental, Also incentives
rewards and punishments that providers face as a may be positive which involve finance such as
consequence of the organizations in which work the salaries, pensions, bonuses, allowances,
institutions under which operate and the specific psychological such as social support, respect and
interventions provide. Also, includes the factors negative incentive such as punishment (WHO,
and/or conditions within health professionals’ work 2008).
environments that enable and encourage them to stay Nurses who feel treated fairly are most likely
in jobs, in the profession, and in countries (WHO, to give their education, experience, and effort to
2008). remain their jobs and would respond to the use of
Incentives can be financial or nonfinancial. incentive with optimism and this sense of optimism
Financial incentives involve the transfer of monetary would have a positive impact on their commitment to
values, such as salaries, pensions, bonuses, the hospital while those, who feel unfairly treated are
allowances, and loans. Non-financial incentives most likely to look for other jobs (Mantler and

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The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.org

Armstrong, 2006). In other words, incentives may Q3. What are the problems of incentive system facing
increase a person’s effort; generally, it is thought that nurses in main Assiut University Hospital and how
monetary incentives will increase effort and overcome them?
performance (Bonner et al., 2002).
Effective incentive systems present a well- 3.3. Design:
designed and supported package, involve input from This study was performed by using cross-
all relevant stakeholders in the design phase, embrace sectional design and Focus Group Discussions
the principles of transparency, fairness and (FGDs).
consistency, fit the purpose for which are intended
and maintain the strategic impact of the incentive 3.4. Study Setting:
components, employ a combination of financial and The present study was conducted in the main
non-financial incentives, carry out regular and Assiut University Hospital including all hospital units
systematic reviews and evaluate impact & motivate that offer incentives which are 23 units and their staff
the target population (WHO, 2008). nurses are 572 and only three units do not offer
The problem lies in the ability to measure incentives includes 165 nurses.
and document the differences between the
employees. This is a normal reason why incentive 3.5. Sample Size:
systems sometimes fail. The lack of objective criteria The sample was calculated using Epi-Info
and measurement spreads mistrust among the statistical package, version 3.3 with power 80%, at
employees towards management. Different 95% level of confidence (CI), with expected
departments within an organization may have prevalence 50%. Accordingly, the sample size was
different conditions to achieve good results, estimated to be 267+ 10% individuals to guard against
depending on what job assignment have. This may non-response rate. The computed sample size plus
cause jealousy (Duberg, 2009). expected dropout rate was 295.

2. Aims of the study: 3.6. Sampling Technique:

The present study aims to: Explore nurse’s awareness A recent list of all health care units in the main
about the incentives system applied at main Assiut Assiut University Hospital was obtained from
University Hospital. Identify nurse’s satisfaction with hospital administration. 295 nurses selected randomly
the incentives system applied at main Assiut from a total number of 737 working nurses in the units
University Hospital and determine the problems of offered incentives or not proportionate to their
incentive system facing nurses in main Assiut numbers in each unit. After an explanation of the
University Hospital. study objectives, 284 nurses (214 from units offer
incentives and 70 from units do not offer incentives)
3. Subjects and Methods: agreed to participate in the study with 96% response
3.1. Significance of the study: rate.
Although nurse job satisfaction has been linked
to retention, a gap remains in identifying specific 3.7. Ethical Consideration:
factors which can be managed or changed to improve Formal administrative approvals were taken
satisfaction and reduce turnover. Knowing that nurse before the start of the study. These included approval
satisfaction is related to physician interactions, by the ethical review committee of Assiut Faculty of
policies, or autonomy provides very broad areas of Nursing, also include approval by the directorate of
interest with few specific actions that can lead to the main Assiut University Hospital. Informed
immediate improvement. Benefits as incentives or consent is taken from the study participants and
disincentives are related to job satisfaction, perceived confidentiality of data is secured.
stress, and intent to stay on their current jobs.
3.8. Pilot study:
3.2. Research Questions: Before starting to collect final data, a pilot
Q1. What about the awareness of nurses’ awareness study was carried out on a sample of 20 who were not
about the incentives system in Assiut University included in the study.
Hospital?
Q2. What is the satisfaction of nurses working in 3.9. Data collection:
Assiut University Hospital with the incentives Data were collected by using both quantitative
system? and qualitative approaches during the period from
February to May 2012. For quantitative data
collection, a semi-structured questionnaire was used

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The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.org

for self-administered and filled anonymously. The (91.5%) were females and 89.7% had children ranged
questionnaire included sociodemographic data and from one to six children and 69% were married and
work characteristics data. Questions to assess nurse's 53.1% of them were residents of rural areas.
perception regarding incentives in the main Assiut As regards the educational level of
University Hospital were measured by incentive respondents, Figure (1) demonstrates that 71.6% of
system questioner that was developed by Shalaby them graduated from nursing secondary schools,
(1997); modified by the researcher to be suitable for 15.5% graduated from Heath Technical Institute,
the nature of the study. It included 11 questions 11.4% had Bachelor of Nursing and few of them
covering the following data: Types of incentives (1.5%) were postgraduates.
offered, the importance of financial and morale As shown in Table (2) and Figure (2), more
incentives applied at work place and important factors than three-quarters of the respondents worked in units
that increase the effectiveness of the incentive system. offers incentives compared with 23% in units do not
The response of participant to the questions using 5 offer incentives. Staff nurses represented 71.6% of the
Likert scales ranged from one (not important) to five sample. Nearly 42% worked more than 10 years. The
(very important). vast majority of studied nurses (96.3%) did not work
The focus group discussion guide explored in any place other than the main University Hospital.
participants’ knowledge, experiences, preferences The public transportation was the main method of
and assumptions about incentives in their work. The transportation to and from the hospital (74.2%).
guide was tested with a group of nurses not included Types of incentives offered in the work place
in the study. depicted in Table (3). Less than half of the participants
Four focus group discussions were conducted (47.6%) received positive incentives and 83.7% of
among 27 nurses from units offer incentives and units them reported that the positive incentives offered
do not offer incentives, two groups for males and two were financial while a morale incentive was reported
groups for females. Focus group discussions were by 0.6%. A high percent of the nurses received
carried out in the nurses' room. Groups ranged in size negative incentives (68.3 %) in the form of sanction
from 6-9 participants and each session lasted 45-60 (59.5%), followed by deduction salary (37.3%) while
minutes. Moderator used the protocol to ask open- the low percent of them reported inequity (3.2%).
ended questions and probe response. Prior to each The importance of financial incentives as
discussion the researcher ensured the issue of reported by studied nurses showed in Table (4). A
confidentiality and they also made sure that there was high percent of them reported that the most important
a relaxed atmosphere before the discussion started. incentives are fair remuneration, bounces, appropriate
The note taker documented the sessions whether working hours, and different services (health/
verbal or non-verbal aspects. All sessions were audio education) (69.7%, 60.9%, 60.5, % 60.5%,
taped after taking permission of the participants. respectively). The promotion, appreciation of work
efforts, good relations with colleagues and superior
3.10. Data Analysis: encouragement were the most important morale
For quantitative data: Questionnaires were incentives reported by 77.1 %, 71.2 %, 66.8 %, 64.6%
reviewed and excluded 13 incomplete instruments, so nurses, respectively.
271 questionnaires were entered into Excel program. Perception of studied nurses of incentives
Data analyzed using SPSS version 16. The system revealed in Table (5). Below half of them
frequencies, the percentages, the mean and the (47.2%) reported that the aim of incentives was to
standard deviation were computed. Chi-squared test compensate the shortage of the main salary, 78.6 %
was used as the test of significance; P < 0.05 was reported that the incentives system applied at their
considered significant. work place didn’t fair, 73.4% thought that the
For qualitative data: The FGDs were translated incentives system applied at their work place need
into English by the researchers. The coded material comprehensive change.
was compared and organized into themes that were Nurse's satisfaction with incentives showed in
then grouped into central categories. The information Table (6). The majority of nurses (87.5%) reported
in each FGD was summarized and grouped according that the incentive system applied in work place did not
to these predefined information categories. satisfy basic (actual) needs of employees, for the
following reason, the administration is not caring to
4.Results: study the employees' needs (54.0%). A high percent
Table (1) shows the socio-demographic of them (81.9%) reported that the incentive system
characteristics of nurses in the present study. The total applied not achieve job security because the following
studied sample was 271 nurses their mean age was reasons, unsatisfied the actual needs of employees;
29.9 ± 7.3 years. The vast majority of the respondents

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don’t provide incentives on a regular basis and 5.4. The relation between the work performance and
unfairness (35.1%, 20.0%, 19.4%, respectively). incentives:
Incentives are certain (if the targeted
5.Results of Focus Group Discussions (FGDs): performance occurs, the employee will receive the
5.1. Characteristics of Participants: extra compensation); the effectiveness of individual
A total of 27 nurses, 12 males and 15 females monetary incentive systems can be attributed to the
participated in the FGDs. The mean age of the fact that when employees are offered individual
participants was 30 years. incentives, with or without guaranteed base pay, the
amount they earn in incentive pay is dependent upon
5.2. Concept of incentives: the number of units of work they complete.
In probing how this concept is known by the Pay-for-performance plans and quality-
participants, we observed that the majority of the monitoring systems had ensured that measuring and
respondents defined incentives as a way to boost reporting patient satisfaction is an important part of
employee productivity “individualized variable pay value-based health care. Support from opinion leaders
based on performance”. of professional organizations is also considered very
helpful to promote the work.
5.3. Types of incentives: About half of the participants reported that
There was a general opinion among all the there is no relation between the offered incentives and
participants that incentives offered in the main Assiut the work performance. They added, payments to
University Hospital are financial in the form of profit nurses are standardized across the main Assiut
share and non-financial incentives to keep morale University without regards to outcomes, quality of
high, reward workers for good effort and meet work care, or years of experience.
goals. Either type should be based on clearly specified Incentives are considered to influence behavior
behaviors or outputs. and attitudes but only when the reward criteria are
About half of the participants, especially clearly known to the recipients. The nurses'
female nurses considered the morale incentives more acceptance of management bonuses tended to depend
important than the financial one especially the good on the direct support provided by the managers.
dealing and the respect from the physicians. One Economic incentives linked to financing conditions of
participant said that "The moral incentive is the most work were seen to be significant for nurses' daily
important. It should be a difference between who lives. In general, nurses were sensitive to efforts to
works hard and who does not work. We must facilitate or impede their work.
encourage the premier even by a certificate of Nurses continued to claim that their
appreciation". interventions could not easily be measured in a
Involvement in decision making, conducive relevant manner (quality versus quantity) although
work environment, participation in professional standards of practice had been developed and were
conferences, job security, working conditions, or job applied during the clinical audit. The potential
prestige, these non-wage characteristics of negative impact of performance-related pay on
employment are more favorable in the public sector. interpersonal relationships within the nursing and
A number of nurses demonstrated that health teams (e.g. competition) was also feared. The
“financial incentives, though important, are not the physicians received the biggest incentive and the
sole reason, and often not the main reason for other amount was divided among the team members,
motivation. Other important motivating factors the resulting reward may be quite small ("peanuts")
include recognition, appreciation, and opportunities and not a sufficient financial incentive.
for career advancement.” 5.5. Rules of incentive distribution:
The bad dealing at work was a general Incentives should be based only on the
statement that was elaborated by the respondents as a employee’s own performance. Benefits as incentives
form of negative incentives used by the work or disincentives are related to job satisfaction,
supervisors or physicians. Other forms of negative perceived stress, and intent to stay on their current
incentives were a rededication of the main salary jobs. One nurse said that "I think an additional
wage and inequality and "ignorance" in the dealing by motivation should be offered to make sure that we are
the boss. Double standards were one of the major practicing good practice".
problems that faced the nurses in their work place
provides a model of inequity that can trigger or 5.6. Problems in the current incentive system:
provoke job dissatisfaction. 5.6.1. The injustice in the incentive distribution:
The governmental hospitals offered more
incentive as 60 Egyptian pounds for night shift

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The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.org

compared to 25 Egyptian pounds in our University Number of children:

Hospital. So, we feel with inequality and many of One 28 16.1
them leave their work and go to work in other places Two 55 31.6
as the private hospital or even travels abroad. There is Three 61 35.1
4 or more 30 17.2
no clear base to incentive distribution. Lack of Mean ± SD (Range) 2.6 ± 1.1 (1 – 6)
motivation of health workers and poor wages were the Type of accommodation:
most important factor affecting health workers’ Ownership 191 70.5
decisions to leave. Rent 80 29.5

5.6.2. Changes after Egypt's revolution and strikes:

After the strike, the financial is better but there Table (2): Work characteristics of the studied nurses
are fears from the unsafe working conditions resulting in the main Assiut University Hospital, 2012.
from the accompanying exceeded beat them if in the Items No. (n= 271) %
case of death of the patient or objection of nurses on Work status:
the presence of visitors while giving treatment to Head nurse 35 12.9
patients. Associate nurse 42 15.5
Most of the participants shared in the strike but Staff nurse 194 71.6
they refused the general strike and very sad because Years of experience:
there were some patients died as a result of the strike. Less than 5 years 48 17.7
5 – 10 years 104 38.4
> 10 years 119 43.9
5.7. Recommendations to improve the incentive Working in a place other than the
system: hospital:
Nurses believed that incentives/disincentives Yes 10 3.7
facilitate should be changed to make reward systems No 261 96.3
more likely to be relevant. While many nurses Place of working: (n= 10)
recommended a general increase in salary as the most Pharmacy 1 10.0
relevant economic incentive, as much importance was Private hospital 2 20.0
given to the relative salary and its impact on social Private clinic 7 70.0
Method of transportation to/from
status as to financial gain. Other suggested economic hospital:
incentives were modest in nature and may reflect On foot 5 1.8
certain personal characteristics of individuals Private car 8 3.0
attracted to nursing. Motorcycle 12 4.4
Hospital's bus 45 16.6
Public transportation 201 74.2
Table (1): Socio-demographic characteristics of the
studied nurses in the main Assiut University Hospital,
2012.
Items No. (n= 271) %
Age: (years)
< 25 years 79 29.2
25 - < 30 61 22.5
30 - < 35 50 18.5
≥ 35 years 81 29.9
Mean ± SD (Range) 29.87 ± 7.34 (19 – 58)
Sex:
Male 23 8.5
Female 248 91.5
Place of residence:
Rural 144 53.1 Fig. (1): Educational level of the studied nurses in the
Urban 127 46.9
main Assiut University Hospital, 2012
Marital status:
Single 77 28.4
Married 187 69.0
Widow 4 1.5
Divorced 3 1.1
Having children: (n= 194)
Yes 174 89.7
No 20 10.3

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Morale
incentives
Participation in 113 41.7 74 27.3 51 18.8 19 7.0 14 5.2
the
administrative
work
A good 181 66.8 66 24.4 20 7.4 3 1.1 1 0.4
relations with
colleagues
Fig. (2): Distribution of the studied nurses according Promotion 209 77.1 47 17.3 8 3.0 5 1.8 2 0.7
to offering incentives or not in the main Assiut Appreciation 193 71.2 55 20.3 17 6.3 2 0.7 4 1.5
University Hospital, 2012. of work efforts
Superior 193 71.2 55 20.3 17 6.3 2 0.7 4 1.5
encouragement
Table (3): Types of incentives offered at the main
Assiut University Hospital, 2012.
Items No. (n= 271) %
Table (5): Nurses' awareness of incentives system in
Positive incentives in work place: the main Assiut University Hospital, 2012.
Yes 129 47.6 Items No. (n= 271) %
No 142 52.4 Aims of the incentives:
Types of positive incentives (n= 129): Compensate the shortage of the main salary 128 47.2
Financial 108 83.7
Employee performance 95 35.7
Morale 8 0.6
Others 13 10.1 Both 37 13.7
Negative incentives in work place: Do not know 11 4.1
Yes 185 68.3
No 86 31.7 Do you think that the incentives system
Types of negative incentives: (n= 185) applied at your work place is transparent
Sanction 110 59.5 enough for the workers?
Deduction from salary 69 37.3 Transparent 18 6.6
Bad dealing by doctors 27 14.6 Transparent some extent 78 28.8
Cancellation of paid vacation 20 10.8 Not transparent 175 64.6
Inequity 6 3.2
Do not know 27 14.6 Do you agree that the incentives system
The most effective type of incentives: applied at your work place fair and
Positive incentives 36 13.3 equitable?
Negative incentives 2 0.7 Yes 58 21.4
Both 188 69.4 No 213 78.6
Do not know 45 16.6
Reasons for injustice: (n= 213)

Table (4): Importance of positive incentives as Does not commensurate with the work effort 113 41.6
reported by the participants at the main Assiut Does not distinguish between the active and 77 28.4
University Hospital, 2012. inactive employees
Most Very Important Important Not Does not encourage the required needs from 23 8.4
important important to some important the point of view
extent The current incentives system:
No. % No. % No. % No. % No. % Does not need to be changed. 2 0.7
Financial Needs to be changed to some extent. 70 25.8
incentives
Appropriate 118 43.5 61 22.5 44 16.2 20 7.4 28 10.3 Needs a comprehensive change. 199 73.4
working hours
Different 144 53.1 59 21.8 46 17.0 18 6.6 4 1.5
services
(health/ Table (6): Nurses' satisfaction with incentives in the
education) main Assiut University Hospital, 2012.
Participation 164 60.5 77 28.4 16 5.9 5 1.8 9 3.3 Items No. (n= 271) %
in profits Do you think that the incentives system
Working 164 60.5 76 28.0 20 7.4 9 3.3 2 0.7 applied in your work satisfies actual
conditions needs of nurses?
Bounces 165 60.9 70 25.8 24 8.9 10 3.7 2 0.7 Yes 34 12.5
Fair 189 69.7 39 14.4 22 8.1 8 3.0 13 4.8 No 237 87.5
remuneration

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If Yes, what are the reasons? (n= 34) gain experience” as the reasons workers decided to
The system changes to achieve the 14 41.2 leave (Stilwell et al., 2004).
constant saturation for these needs. In the present study high percent of nurses
The ability of individuals to 13 38.2 reported that the most important incentives are fair
communicate their wishes and needs, remuneration, bounces, appropriate working hours,
which reflect the satisfaction. and different services. The promotion, appreciation of
An ongoing study by management to 7 20.6
work efforts, good relations with colleagues and
the needs and motivations of
superior encouragement were the most important
employees.
If No, what are the reasons? (n= 237) morale incentives reported by more than two third.
Also, from the Focus Group Discussions about half of
The hospital administrators were not 128 54.0
the participants especially female nurses considered
caring to study the employee’s needs.
The system is applied without
the morale incentives are more important than the
consideration of the actual needs of the 117 49.4 financial one especially the good dealing and the
employees. respect from the physicians. These results are agreed
Employees incapable to express their 74 31.2 with other studies that demonstrated financial
wishes and opinions. incentives, though important, are not the sole reason,
Do you think that the incentives system and often not the main reason, for motivation. Other
achieves the nurses' job security? important motivating factors include recognition,
Yes 49 18.1
appreciation, and opportunities for career
No 222 81.9 advancement (Dieleman and Harnmeijer, 2006). Non-
If no, what are the reasons? (n= 222) financial rewards are particularly vital for countries
Unsatisfied the actual needs of 95 35.1 and organizations where limited funding constrains
employees their capacity to provide financial rewards (Alamri,
Does not provide incentives on a 54 20.0 2011). This is on the same line with the study findings
regular basis of ICN (2008) as non-financial incentives, involving
Unfair 52 19.4 work autonomy, flexibility hours, and scheduling,
Inflexible 36 13.3 recognition of work and support for career
development, etc.) Play an equally crucial role. This
is in well-resourced countries where the staff is able
6.Discussion: to maintain a high standard of living, as well as in
Policy makers, planners, and managers are relatively poorly resourced ones.
challenged to identify and apply a combination of Wieck and other researchers (2009) found that
financial and non-financial incentives that are the most important incentives were the work
responsive and effective in meeting policy objectives environment described as cohesive work
related to recruitment and retention (ICN, 2005). environment: working with people who help you,
Incentives and incentive systems are fundamental to share the work and pull together as a team. The least
developing capacities and translating these capacities important preferences were fairly consistent across
into better performance (Wignaraja, 2006). generations: luxury items, day care, and subsidized
From the findings of the present study, 77% of transportation.
the respondents received incentives from their work The majority of nurses in our study reported
places but 47.6% reported that positive incentives that the incentive system applied in work place did not
offered in their work place either financial or non- satisfy basic needs of employees. Only 0.7% of them
financial. On the other hand, more than two-thirds of satisfied by the present incentives system. This is in
the respondents reported negative incentives in the consistence with the findings of other study conducted
form of sanction, deduction from salary, bad dealing by Wick et al. (2009) as they found that over three-
by doctors etc.13.3% believed that positive incentives quarters (78.5%) satisfied by their incentives system.
are more effective than the negative ones but 69.4% Also, it is consistent with the findings of Armstrong
thought the both types of incentives are required in the and Cameron (2005) and Baumann et al. (2006) as the
work place. A study exploring the factors affecting salary inequity is clearly the major barrier for
motivation of health workers in six African countries recruitment and retention as indicated by both nurse
found that poor wages in countries like Uganda and leaders and front-line staff. Nurses' perceptions of
Zimbabwe were the most important factor affecting rewards and their possible impacts have been
health workers’ decisions to migrate. However, in examined by Kingma (2003) using individual
Cameroon wages factored below “lack of promotional interviews, focus groups and observations. She
opportunities, poor living conditions and a desire to identified two main categories of economic rewards:
the financial incentives (e.g. salary and petrol

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The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.org

allowance) involved a monetary transfer to the nurses, can (when implemented properly) be positive and
whereas the financed rewards (e.g., subsidized deliver performance improvement, especially when it
continuing education and paid sabbatical leave) gives a financial reward to employees for reasons of
represented a cost for the employer without any both equity and recognition and gives direction to
monetary transfer to the nurses themselves. employees by aligning rewards with the
From the findings of the present study, 78.6% organization’s goals and objectives. It is based on the
of the respondents confirmed the current incentive performance of groups, individual performance and
system does not achieve justice, this is due to for the rewarded by honors. In short, total reward programs,
following reasons, does not commensurate with the which integrate both financial and non-financial
work effort (41.6%) and does not distinguish between incentives to reward staff, can offer an organization
the active and inactive employees (28.4%). the building blocks to help incentives, recognize and
In Focus Group Discussions about half of the motivate employees to deliver improved levels of
participants especially female nurses considered the performance (Gieter, 2006).
feel with inequality and many of them leaves their Respondents recommended some issues to
work and go to work in other places as the private improve the current incentive system in the main
hospitals or even travels abroad, there is no clear base Assiut University Hospital such as a general increase
to incentive distribution. These results are agreed with in salary as the most relevant economic incentive, as
other studies that demonstrated that the fairness in much importance was given to the relative salary and
distribution the incentives affects the manner in which its impact on social status as to financial gain.
individuals view their jobs and the organization, and Improving nurses’ work environments, including
it can affect the amount of effort they expend in nurse staffing, meals, and safe working environments.
accomplishing tasks (Kingma, 2003). An open Other researchers have shown that a positive working
procurement process, fair treatment in awarding the environment is an important element in efforts to
contract to the best bid, is important in building recruit and retain staff (Buchan, 1999; Gilson et al.
investor confidence (Ajayi et al., 2002). 2004; ICN 2007b). This includes providing a safe
In the present study, high percent of working environment for staff and proactively
respondents (81.9%) believed that the incentive responding to emerging risks, as well as creating a
system applied in main Assiut university hospital did positive organizational culture can play a role in
not achieve job security, this is due to the following providing a positive environment where people will
reasons, unsatisfied the actual needs of employees, do want to work.
not provide incentives on a regular basis and unfair
(35.1%20.0%, 19.4%, respectively). This is 7.Conclusion:
consistent with study found out the reasons behind the Less than half of the participants received
request of nurses move outside the hospital, the positive incentives in the form of financial rewards.
findings showed that the vast majority of the The promotion, appreciation of work efforts, good
respondents believe that the basic requirements, and relations with colleagues and superior encouragement
services, and facilities provided by the hospital is one were the most important morale incentives reported
of the main reasons behind their desire to move, as by participants. Both the qualitative and quantitative
well as ventilation and amplitude and public services, data revealed that a number of psychological and non-
leisure and material and morale incentives is one of financial rewards were important for nurses in
the reasons behind the request to move (Khleifat et al., addition to their monthly pay and other
2013). remunerations.
From the findings of the present study, below
half of the studied nurses reported that the incentives 8.Recommendations:
aim to compensate the lack of basic wage (42, 2%). In The study recommended that: Integrating
congruence with these findings of Pritchard et al. between different types of incentives system should
(2010) found that the monetary incentives effect on include incentives both the financial and morale
goal choice, goal commitment, and task performance. especially the promotion, appreciation of work
In Focus Group Discussions about half of the efforts, good relations with colleagues and superior
participants reported that there is no relation between encouragement together. Determine of the incentive
the offered incentives and the work performance. system objectives are the most important factors to
They added that currently payments to nurses for their increase the effectiveness of the incentive system and
services are standardized across the main Assiut achieve justice in the distribution of incentives, and
University without regards to outcomes, quality of periodic assessment of incentives must examine the
care, or years of experience. Results are agreed with efficiency and utility of it.
other studies that demonstrated pay for performance

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 The Journal of Middle East and North Africa Sciences 2016; 2(3) http://www.jomenas.org

Corresponding Author: performance: preliminary national overview

Ekram M. Abdel Khalek, Ph.D. report: South Africa. Unpublished report.
Assistant Professor of Public Health & Community 10- ICN (2007a): Positive practice environments:
Medicine, Faculty of Medicine, Assiut University, quality workplaces quality patient care, ICN,
Egypt. Geneva, accessed 19 February 2008.
E-mail: [email protected] 11- ICN (2007b): Incentives and the
recruitment/retention of nurses, A paper
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Received February 08, 2016; revised February 10, 2016; accepted February 11, 2016; published online March 1,
2016.

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