There is increasing attention to nursing workforce issues such as recruitment, retention, turnover, workplace health and safety issues and their impact on quality patient care. A number of these problems have been linked to poor morale. While there has been a lack of consensus on the determinants of morale, it is clear that the outcomes of poor morale not only add considerable cost to the organisation but also impact negatively on patient care. This article provides a systematic overview of the literature surrounding nursing morale and the variables identified in the literature that impact upon morale, and discusses the implications for future research.
Aust Health Rev 2006: 30(4): 516-524
THERE IS INCREASING worldwide attention given by researchers, policymakers and administrators to nursing workforce issues such as recruitment and retention, turnover and workplace health issues. The contemporary literature has linked issues such as absenteeism,1-3 retention and recruitment,4,5 staff turnover,6,7 and health issues such as increased staff accidents and health risks8,9 to low morale. As a result of low morale, these poor organisational outcomes are not only costly to the organisation but can also have serious impacts upon the health and wellbeing of staff and, as a consequence, place patients at risk of lower quality care and potentially adverse clinical outcomes.3,10
Staff morale is a workforce phenomenon that confronts every organisation at some time. The understanding of morale is imponant because it can have tangible and wide-ranging effects and outcomes for an organisation. Morale is not a simple concept and the outcomes associated with high or low morale may impact upon staff turnover, attainment of organisational or personal goals, the ability to adopt new practices, learning new skills and the delivery of good customer service.11 As early as the 1940s morale was being viewed as an important workplace issue. At the time, it was suggested that when any person holds a position of responsibility in a business, the word "morale" comes to have real meaning and refers to something that has great importance, even if that something remains vague and illusive. At times the feelings of poor morale are difficult to articulate by those that are affected by it.12 While there are a number of thematic variations on the definition of morale, for the purposes of this review, positive morale is seen as an attitude of confidence in the mind of the individual where they identify with a group, accept group goals and work towards achieving them collectively.13 The fact that there has been no unifying definition of morale goes some way to explaining the reasons why definitive empirical studies on the phenomenon have been somewhat sporadic.
The morale of nurses
A number of the writings concentrate on poor morale of health care workers and highlight a range of causes including: shortage of workers;14 overwork;15-20 low pay and difficulties with the recruitment and retention of staff;15,19-22 the quality of nursing education;15,23 professional support and prospects;15,21 and the lack of recognition for job performance and professional achievement.19,22 The way a person responds or reacts to work and organisational stimuli has a strong bearing on their subsequent perception of morale within the workplace.
As shown in the Box, the literature surrounding the morale of nurses can be divided into a number of key themes. Equally, the themes can be separated into those that could be considered intrinsic or personal factors, and those that are more extrinsic or structural factors. This paper reviews the literature that relates to these themes and offers some suggestions on the implications of current knowledge related to morale and future research directions.
Intrinsic factors are those variables that impact upon nurses' concept of personal or professional standing within the group. …