Hello student. Features of the professional motivation of a nurse in domestic and foreign psychology Model of work of a nurse personality activity communication

1, 2 Levina V.A. 12Kuznetsova E.V. 12Lunkova O.A. 12

1 NGO HPE "Saratov Branch of the Samara Medical Institute" REAVIZ "

2 GOU SPO "Engels Medical College", Engels

As a result of the theoretical and practical studies carried out, based on the analysis of various theories on the study of motivation, it can be concluded that the motivational sphere of a person is very complex and heterogeneous. With knowledge of the motivational factors that are highly valued by employees, leaders of nursing teams can think over and build a system of encouragement and incentives that meets the requirements of efficiency. As can be seen from the study, even in the presence of employee satisfaction with the working conditions, it is possible to highlight a number of points based on a qualitative analysis of individual questionnaires that will allow the manager to improve the efficiency of his management. So, the scope of knowledge on motivation is very extensive. And the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.

nurse

motivation

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3. Aseev V.G. Motivation of behavior and personality formation. - M., 1976.

4. Bodalev A.A. Motivation and personality. Collection scientific papers. - M.: Publishing House of the APN USSR, 1982.

5. Vilyunas V.K. Psychological mechanisms of human motivation. - M., 1990.

6. Dvoynikov S.I. Management in nursing. - Rostov n / a.: Phoenix, 2006.

7. Dessler G. Personnel management. - M., 1997.

8. Zagorodnova G.A., Pavlov Yu.I. Characteristics of job satisfaction and production motivation of nurses // Chief Nurse. - 2008. - No. 3.

Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts. One of the simplest and most common definitions of motivation: motive is the intrinsic value of the activity performed. In the most approximate sense, such a definition reflects the internal state of a person, however, it should be noted that the forces that impel to action are outside and inside a person and force him to consciously or unconsciously perform certain actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react in completely different ways to the same effects from the same forces.

Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. This is where the concept of motivation comes in. Motivation is the process of influencing a person in order to induce him to certain actions by awakening certain motives in him.

The purpose of the work: to determine the practical application of psychological knowledge about motivation in the management of nursing staff in healthcare facilities.

In order to identify motivational factors for nurses of the urological department, we conducted a survey of the nurses of the department. 20 respondents took part in the survey. The survey used the Martin-Ritchie Motivational Profile test, aimed at identifying the needs and aspirations of each employee, and thus getting some idea of his motivational factors. As such, the authors identified 12 needs.

In high wages and material rewards.

IN good conditions work and a comfortable environment.

In a clear structuring of work, the availability of feedback and information that allows you to judge the results of your work; the need to reduce uncertainty and establish rules and directives.

In social contacts; in the formation and maintenance of long-term stable relationships with a small number of colleagues, while the degree of closeness of relationships, trust is important.

Need in more free time.

In winning recognition from others, in making others appreciate the merits, achievements and successes of the individual.

In setting challenging goals and achieving them.

In influence and power, the desire to lead others; persistent desire for competition and influence.

In diversity, change and stimulation; in an effort to avoid routine.

In creativity; desire to be an analytical, thinking worker, open to new ideas.

In improvement, growth and development as a person.

In the feeling of being in demand, in interesting work filled with meaning and significance with an element of social utility.

The test is based on a comparison of the significance of a number of motivational factors that are important from the point of view of personnel management. Conducting a local study in the organization allows us to conclude that certain motivating factors predominate and thus creates a picture of the motivational environment.

The data we obtained allow us to characterize the motivational environment as follows: high and stable earnings are important and valuable for employees, the opportunity to work in good conditions, the need for recognition by management and colleagues of their merits, achievements and successes (Fig. 1). Among the factors, the stimulation of which will be considered ineffective, employees noted the need for socially useful work, maintaining and forming long-term relationships with a small circle of colleagues, as well as the need for power, clear structuring of work, and manifestation of a creative non-standard approach (Fig. 2).

Rice. 1. Motivational factors highly valued by employees

With such data, the head nurse can think through and build a system of encouragement and incentives that meets the requirements of efficiency. The presence of non-dominant factors may indicate either sufficient satisfaction in this regard, or a lack of interest in this factor. Satisfying the dominant needs will help to improve the efficiency and quality of work.

Based on the foregoing, the urological department has a high potential for enhancing the work of nurses. These are incentive payments at the expense of established bonuses for performance, taking into account quality criteria.

For our study, we used the Job Satisfaction Test. This is a standard test used in the study of factors influencing motivation, and allows you to identify parameters that satisfy or dissatisfy the employees of the organization with working conditions, management organization and relationships in the work team.

Rice. 2. Non-dominant motivational factors

This test contains 14 statements, each statement can be evaluated from 1 to 5 points. In assessing the satisfaction with the work of the workforce, average values of indicators are used. In this case, the results are evaluated according to the following scale:

15-20 points are quite satisfied with the work

21-32 points satisfied

33-44 points are not quite satisfied

45-60 points are not satisfied

over 60 points highly dissatisfied

The respondents were given the following instructions:

Make your choice for each of these statements by ticking the appropriate number.

1 - quite satisfied;

2 - satisfied;

3 - not quite satisfied;

4 - not satisfied;

5 - extremely dissatisfied.

	Statement
	Your satisfaction with the company where you work
	Your satisfaction with physical conditions (heat, cold, noise, etc.)
	Your job satisfaction
	Your satisfaction with the coherence of the actions of employees
	Your satisfaction with your boss's leadership style
	Your satisfaction with the professional competence of your boss
	Your salary satisfaction in terms of matching with your labor costs
	Your satisfaction with your salary compared to how much other companies pay for the same job
	Your satisfaction with official (professional) promotion
	Your satisfaction with your promotion opportunities
	Your satisfaction with how you can use your experience and abilities in your job
	Your Satisfaction with Job Requirements to Human Intelligence
	Your satisfaction with the duration of the working day
	To what extent would your job satisfaction affect your decision if you were currently looking for a job?

11 nurses took part in the testing. It should be noted that 7 nurses were absent at the time of the survey (vacation, sick leave, etc.) and one person refused to take part in the survey, explaining his refusal by the fact that nothing would change from his answers. The structure of the admission department includes a trauma center. The emergency room nurses were interviewed along with the admissions department nurses. Therefore, the test result can be attributed to the entire structural unit. But I immediately wanted to note the fact that those nurses who took part in the study took the proposed task seriously. They carefully listened to the instructions, enthusiastically and thoughtfully began to complete the task. This can serve as an indicator of the significance of the test results for them, as an opportunity to express their opinion on these issues. And for us, this can serve as an indicator of the importance of conducting this kind of research.

In the course of the study, we obtained the following result: the average value obtained as a result of dividing the sum of the results for each individual questionnaire by the number of survey participants is 24.5 points, which corresponds to the “satisfied” indicator on the test scale. Thus, in general, the team is satisfied with the conditions and characteristics of work at this enterprise and specifically in the admissions department (Fig. 3).

But we could see the full picture only by conducting a qualitative analysis of the results. It should be noted that against the background of overall job satisfaction in general, there is a differentiation of results for individual questionnaires.

So, one person is completely satisfied with all the parameters of labor activity, that is, each proposed statement, he estimated at 1 point - “quite satisfied”; four more people rated each statement either at 1 point or at 2 points - “satisfied”, that is, they are also satisfied with the conditions that the organization offers them.

In the questionnaires of the rest of the study participants, a negative assessment of working conditions appears.

For three employees, this dissatisfaction is manifested only once, that is, they rate any parameter at 3 points - “not quite satisfied”. Moreover, these parameters are not related to these survey participants. So, one of them is not satisfied with the length of the working day at the enterprise, the other is not satisfied with the salary, in comparison with other organizations, and the third is not fully satisfied with the requirements of work to the human intellect. But in general, according to the sum of points (24.25 and 26) obtained as a result of processing the questionnaires of these employees, they belong to the category of employees who are satisfied with their work, that is, we can combine them into the previous group.

Thus, three more questionnaires remain in our field of vision. Let us immediately make a reservation that two of them have total scores (27 and 31), corresponding to the “satisfied” indicator on the key scale, but since many statements are rated as not quite satisfactory, we will consider them in more detail along with the questionnaire, the result of which by the sum of points (34) corresponds to the indicator "not quite satisfied".

The first of the employees (27 points) is not fully satisfied with the coherence of the actions of employees and those parameters that characterize the possibility of using their potential and the possibility of promotion. The second and third employees (31 and 34 points) are also dissatisfied with career advancement and opportunities for their advancement, and one of them is not completely satisfied with the length of the working day and is not satisfied with wages compared to other organizations, while the other is not satisfied with work at all.

Thus, it can be concluded that along with nurses who are satisfied with their work, there are employees who are not completely satisfied with some parameters of work, although they are generally satisfied with their work, and also one employee is not completely satisfied with the work as a whole and is not satisfied with some of its parameters. Moreover, it is interesting to note that all of them are not satisfied, in general, with the possibility of promotion. Although two of them are dominated by dissatisfaction with the content of the work (job satisfaction, the use of their experience and abilities), then one employee, against the background of the same dissatisfaction with promotion, clearly dominates external motivating factors (working hours, wages).

So, we can conclude that even with general satisfaction with the work of the entire team, based on a qualitative analysis of the results of the survey, it is possible to see a number of features of the motivation of individual employees and, with the help of properly selected management techniques, increase the efficiency of each employee in order to optimize the work of the entire health facility. So, in our case, for two employees, the greatest motivating beginning will be the opportunities provided for realizing their potential, recognizing their labor contribution and praise for responsible work, as well as the opportunity to see the prospect of development, advancement in the future (this should not be understood as an immediate increase, but putting their candidacy on the reserve list will serve as a powerful impetus to the work, while not obliging the administration to anything). Unlike the previous example, for an employee focused on external incentives, external incentives (bonuses, benefits, compensatory time, etc.) will serve as a strong motivational factor, respectively.

Rice. 3. Satisfaction with the work of nurses in the admission department

Staff motivation is an important component in personnel management, as well as a direct way to improve the quality of nursing care with the skillful use of knowledge of the motivation structure and their application in practice.

The art of management is to clearly represent human needs and create the necessary conditions to satisfy them.

Conclusion

As a result of our theoretical and practical research, based on the analysis of various theories on the study of motivation, we can conclude that the motivational sphere of a person is very complex and heterogeneous.

In modern psychology, there are currently many different theories, the approaches of which to the study of the problem of motivation are so different that sometimes they can be called diametrically opposed.

When studying various theories of motivation, when determining the mechanism and structure of the motivational sphere, we came to the conclusion that human motivation is indeed a complex system, which is based on both biological and social elements, therefore, it is necessary to approach the study of human motivation, taking into account this circumstance.

It is also important to note the importance of knowledge about motivation in the management activities of the management of an organization interested in increasing the productivity of its employees, their full return at the enterprise. Understanding and putting into practice the system of motivation of their employees will lead not only to a general increase in the efficiency of the organization, but also to job satisfaction of the employees themselves, and an improvement in the psychological climate. And, as a result, again, an increase in the productivity of the organization itself. A competent leader must clearly know that not all employees are motivated equally. Therefore, he must accurately recognize the actual motives of each of his employees and try to meet the needs of each as far as possible.

With knowledge of the motivational factors that are highly valued by employees, leaders of nursing teams can think over and build a system of encouragement and incentives that meets the requirements of efficiency.

As can be seen from our study, even if employees are satisfied with the working conditions, it is possible to highlight a number of points based on a qualitative analysis of individual questionnaires that will allow the manager to improve the efficiency of his management.

So, the scope of knowledge on motivation is very extensive, and the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.

Reviewers:

Andrianova E.A., Doctor of Social Sciences, Professor, Head. Department of Philosophy, Humanities and Psychology, Saratov State Medical University named after V.I. Razumovsky Ministry of Health and Social Development of the Russian Federation, Saratov;

Novokreshenova I.G., Doctor of Medical Sciences, Associate Professor, Head. Department of Economics and Management of Health Care and Pharmacy, Saratov State Medical University named after V.I. Razumovsky of the Ministry of Health and Social Development of the Russian Federation, Saratov.

The work was received by the editors on February 2, 2012.

Bibliographic link

Maslyakov V.V., Maslyakov V.V., Levina V.A., Levina V.A., Kuznetsova E.V., Kuznetsova E.V., Lunkova O.A., Lunkova O.A. MOTIVATION IN THE ENVIRONMENT OF NURSES // Basic Research. - 2012. - No. 3-2. - S. 352-357;
URL: http://fundamental-research.ru/ru/article/view?id=29607 (date of access: 02/01/2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

The study of the work motivation of nurses is becoming an urgent topic in connection with the tasks that are set for the domestic health care. In the "Concept for the development of the health care system in Russian Federation until 2020” states that one of the main directions of reforming the industry is to address issues related to its staffing. Nursing staff bears the bulk of the burden of caring for patients, performing medical diagnostic and preventive measures, and the number of paramedical workers is more than 2 times higher than the number of doctors. In the structure of assessing the quality of medical care, as studies show, the professional activity of nursing staff ranks third after the performance indicators of doctors and the effectiveness of therapeutic measures. At the same time, the key to improving the efficiency of the quality of medical care to the population is the creation of conditions for motivated work of medical personnel. Meanwhile, the number of works that consider the work motivation of Russian medical personnel is very limited (V.V. Madyanova, V.A. Mansurov, O.V. Yurchenko, M.A. Tatarnikov, N.V. Kungurov, N. V. Zilberberg, D.I. Prisyazhnyuk, S.V. Shishkin, A.L. Temnitsky, A.E. Chirikova, etc.), and there are practically no studies of the work motivation of nurses.

According to the classical theory of A. Maslow, the behavior of the individual is directed by the need that is actualized at the moment. At the same time, scarce needs, which are needs of a lower hierarchical level, stimulate human activity until they are saturated. On the contrary, needs related to a higher level, when they are actualized, are capable of further growth. The development of this theory is contained in I.G. Kokurina; she notes that in labor activity each motive has two semantic orientations: procedural and resulting. Procedural semantic orientation means that a person's activity is limited by the given scope of activity. The resulting semantic orientation is a higher level of activity, it makes a person go beyond the limits of activity prescribed for him.

The motives of employees that encourage them to engage in work activities can vary significantly. At the same time, it is possible to single out certain types of labor motivation. IN AND. Gerchikov proposes to use a typological model of labor motivation, which is built on the intersection of two differently directed axes: “achievement or avoidance motivation” and “active and constructive or passive and destructive labor behavior”. The author identifies four basic types of achievement motivation: instrumental, professional, patriotic, mastery and one opposite type - avoidant.

The basis of psychological analysis professional activity nurse is the fundamental methodological principle of the unity of consciousness and activity, which is most fully implemented from the standpoint of a system-structural approach. Based on this approach, in the process of performing the professional activities of a nurse, a self-forming and self-developing system of mental regulation of activity is formed, which affects all structures and formations of activity, affects all areas of mental activity. When studying the professional activity of a nurse from the standpoint of a system-structural approach, her activity should be considered as a socio-psychological system "nurse - team - patient". The functional elements of this socio-psychological system determine the achievement of the goal, which is a system-forming factor.

The purpose of the professional activity of a nurse is defined as the provision of qualified medical care to the population in accordance with the requirements of the State Educational Standard for the relevant medical specialty. In accordance with the Code of Ethics of the Russian nurse, the most important tasks of the professional activity of a nurse are: comprehensive comprehensive care for patients and alleviation of their suffering; health recovery and rehabilitation; promotion of health and disease prevention. The profession of a nurse refers to professions of the “person-to-person” type, where work is combined with increased moral responsibility for the mental and physical condition of the patient. In the specialty "nursing" the main form of activity is the nursing process - a method of organizing and providing nursing care, which includes the patient and the sister as interacting persons.

The features of the professional activity of a nurse place significant demands on the psychological characteristics of a specialist. To obtain initial data on the psychological factors that ensure the effectiveness of the professional activity of a nurse, the method of peer review is of undoubted value. This method makes it possible to explore the representation of the subject of labor about the significance of certain psychological characteristics for the successful implementation of their professional activities. In the course of generalizing and systematizing the data, the following areas were identified: cognitive, motivational, communicative, characterological, emotional and volitional.

Among the cognitive characteristics necessary for successful work, experts identified the following: professional erudition, observation, creative mindset, memory, attentiveness. In the motivational sphere, the experts identified the following characteristics: the desire to help people, the desire to improve one's personality, the desire to achieve the heights of mastery. In the communicative sphere, experts noted sociability, openness, listening skills, and sociability. In the characterological sphere, the experts noted the following psychological characteristics: goodwill, honesty, self-confidence, optimism, accuracy, punctuality, politeness, tact, conscientiousness, selflessness. In the emotional sphere, the expert analysis revealed the following characteristics: stress resistance, endurance, compassion. In the volitional sphere, experts have identified: discipline, determination, diligence, organization, independence, perseverance, diligence, consistency, vigor, initiative.

High efficiency professional activity of a nurse is possible only with optimal labor motivation in combination with professionally important qualities identified in the course of an expert assessment.

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Ministry of Health and Social Development of the Russian Federation

State budgetary educational institution of higher professional education

"Chita State Medical Academy

Ministry of Health and Social Development"

Department of Public Health and Health

Internship in the specialty "Management of nursing activities"

Topic: "Motivation in the work of nursing staff"

Completed by: Podorozhnaya N.V.

Chita, 2013

Introduction

Chapter 2

Conclusion

Bibliography

Introduction

Staff stability is one of the conditions effective work of any firm, and the struggle for low staff turnover is a problem that is especially relevant for areas such as healthcare and pedagogy. To solve it, one must be able to predict the situation, learn to manage the process of staff turnover. And one of the first steps here can be a study showing how satisfied employees are with their jobs. Often, satisfaction is understood as the retention of an employee in the enterprise.

The problems of increasing the labor motivation of medical workers are the most important function of healthcare management. Without their solution, it is hardly possible to really improve the quality and culture of providing medical care to the population, as well as increase the efficiency of the activities of medical institutions (HCIs) and the industry as a whole on the basis of rational use financial, material and human resources. It has now been proven that money does not always induce a person to work harder (although no one downplays the role of material interest!). The problems of increasing labor motivation are systemic in nature and require an integrated approach to their solution.

The relevance of the study lies in the fact that by studying satisfaction, one can obtain information about the strength of staff attachment to the enterprise. Here it is appropriate to talk about material and moral incentives for employees. Job satisfaction data is information about personnel risks. It is important for any leader who does not want to be a hostage to the current situation. The problems of motivation and stimulation of personnel are widely considered today in the scientific and journalistic literature. However, attempts to adapt the classical theories of motivation to the present are largely not systematized, which makes it difficult to use the technologies and methods of motivation in practice. The complexity of the practical organization of the personnel motivation system is also determined by the poor study of the characteristics of the motivation of workers employed in certain sectors of the economy and types of production. It is quite obvious that in different fields of activity there is a professional specificity of motivation. The urgency of the problem is also due to the rigidity of the management system in health care, which has largely retained the features of management that are characteristic of the socialist planned system and do not fit into modern market conditions. In most health care institutions, the possibilities of material stimulation of labor are limited by the lack of funds, so special attention should be paid to the means of non-material motivation of nurses. Given the limited material resources of health care, the effective and adequate value orientation of the personnel of a particular medical institution, non-material form of motivation, is of particular relevance. As the material and technical base of health care is strengthened, the issues of personnel management in its not material, but socio-psychological aspect will increasingly arise before the heads of medical institutions. Increasing the work motivation of nurses is topical issue, the significance of which is especially high in connection with the reform of healthcare and the implementation of the National Project in the field of health. Managers should clearly understand the importance of motivation as one of the management functions and use every opportunity to reduce the factors that demotivate nurses.

The purpose of the study is to consider the essence of motivation in the work of nursing staff, while analyzing the factors that motivate their work.

1. Consider and systematize the theoretical foundations for studying the motivational orientation in work.

2. Summarize information about the motivational orientation of medical workers.

3. Carry out a practical study of job satisfaction and increasing the work motivation of nurses using the example of 321 OECS.

The object of the study is the nurses of health facilities.

The subject of the study is the features of the motivational orientation of nurses.

When conducting this study, the following research methods were used:

Analytical (analysis of the received data);

Sociological (questioning);

Statistical (data from reporting documents).

Course work consists of an introduction, two chapters - theoretical and practical, conclusion and list of references.

Chapter 1. Theoretical aspects of labor motivation in medicine

1.1 Problems of labor motivation in medicine

Increasing the labor motivation of personnel is one of the priority tasks of management in any field of activity. Of particular importance is the solution of this problem in the field of healthcare in connection with the tasks set in the "Concept for the development of the healthcare system in the Russian Federation until 2020" .

Nursing is an integral part of the health care system, aimed at solving the problems of individual and public health of the population in a changing environment. environment. Nursing includes health promotion, disease prevention, psychosocial care and care for individuals with physical and/or mental illness, as well as disabled all age groups. According to the Central Research Institute of Health Organization and Informatization in 2012, the number of nurses in the Russian Federation was 1327.8 thousand people. Nursing is part of the health care system, which has significant human resources and real potential to meet the needs of the population for quality and affordable medical care.

Despite the tasks set for healthcare, at the present time in the development of nursing there are still some trends that negatively affect the state of labor motivation of nurses.

One of the main reasons affecting the labor motivation of staff is the level of material remuneration for work and the feeling of fairness of this remuneration. For workers with external motivation, this factor can be of decisive importance not only as a factor supporting and regulating the motivational state, but often play a decisive role in deciding whether to continue working in a particular organization and in medicine in general. For internally motivated workers, of course, other factors are of greater importance, but the low level of wages makes them also experience significant dissatisfaction.

The vast majority of both patients and doctors underestimate the contribution of a nurse to the diagnostic and treatment process; doctors do not know how and are not focused on building equal partnerships with nurses, they do not recognize higher nursing education, and even more so, an increased level of secondary professional education of nurses. Historically, there was an idea of a nurse as an assistant to a doctor, his "right hand", an appendage. “[The nurse] must begin her work with the thought firmly implanted in her head, the thought that she is only the instrument by which the doctor carries out his instructions; it does not occupy an independent position in the process of treating a sick person" (McGregor-Robertson, 1904).

Despite a whole century separating us from this statement, at the present time, little has changed in this mentality. Many doctors directly or indirectly express their superiority, allow incorrectness in relation to nursing staff, all this acts as a factor that significantly reduces the desire to work.

The high degree of physical and psychological stress on nurses, the underdevelopment of coping strategies, as well as a number of organizational factors contribute to the rapid development of professional burnout syndrome, which, according to various authors, affects from 40 to 95% of paramedical workers. The burnout of medical workers significantly deforms the system of value orientations of the individual, emphasizing material values to the detriment of spiritual ones, and shifts labor motivation from internal to external.

The low level of wages provokes unofficial sources of income, with the help of which workers try to satisfy not only the need for fair material remuneration for work, but also the need for recognition and respect. It is she who is one of the leading internally motivated workers in the structure of labor motivation, which are often doctors. The lack of recognition is compensated by replacing it with a monetary equivalent and material symbols, with a clear lack of opportunity to do this with the help of wages, there is a shift in emphasis to unofficial sources. Although it should be noted that we are talking more about doctors; paramedical workers are much less able to use informal means of remuneration. Moreover, it is smaller opportunities, but no less desire. In this situation, nurses experience a growing sense of injustice, which leads to the disunity of the “doctor-nurse” tandem, affecting the quality of treatment and reducing the labor motivation of the latter. But the problem of deformation of the value-motivational system of medical workers is of particular importance in this situation. Behind the visible side of this problem, there is another one: informal payments are beginning to be recognized as a significant incentive that encourages nurses to work better, and students to choose a medical profession, i.e. included in the system of labor motivation. The collection of unofficial payments, in addition to the legal aspect of the problem, is fundamentally contrary to the principles of biomedical ethics, discredits the public health system, and negatively affects the quality of medical care and the prestige of the medical profession.

There are still very limited opportunities for self-improvement and training of nurses: mandatory advanced training is carried out once every 5 years, opportunities for the exchange of experience between the average staff of various medical institutions are not used enough, methods of intra-organizational training are little used: horizontal rotation of personnel, "young nurse school" and other forms of education. Meanwhile, the realization of the need for training and development on the one hand, and the participation of nurses themselves in pedagogical activity on the other hand, they have a powerful motivational potential for a significant part of employees.

In the "Concept for the development of the healthcare system in the Russian Federation until 2020" one of the priority tasks is the development of "infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization", which is designed not only to improve the quality of medical care, but also to promote the development labor motivation of personnel.

The personnel management system needs to be improved. Currently, there is practically no hierarchy in the system of organization of nursing. Career opportunities are very limited: Nurse, Head Nurse, Head Nurse. Only in some health facilities there are such positions as a specialist in training nursing staff, a specialist in quality control of nursing activities. For example, positions such as foreman or shift supervisor, nurse-mentor are not provided. The introduction of a number of such positions could serve the career aspirations of some nurses and a more differentiated approach to the issue of remuneration.

The prestige of the profession of a nurse, as noted earlier, plays one of the significant roles in the structure of the labor motivation of nurses. Most of the reasons listed above are directly or indirectly related to the position that this profession occupies in society. Raising the prestige of a profession is not so easy, and this is a common task not only for the healthcare system, but also for the cultural state of the whole society, the hierarchy of social values. Western-style labor motives and values introduced into the mass consciousness of Russians from the outside do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements economic development. The decrease in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere. There is no widespread propaganda of the social significance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture. Increasing the work motivation of nurses is an urgent problem, the significance of which is especially high in connection with the healthcare reform and the implementation of the National Health Project.

1.2 The concept and essence of staff motivation

Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts.

Motivation can be defined in different ways. On the one hand, motivation is the process of encouraging oneself and others to act in order to achieve personal or organizational goals. On the other hand, motivation is the process of a person's conscious choice of one or another type of behavior, determined by the complex influence of external (stimuli) and internal (motives) factors. In the process of production activity, motivation allows employees to satisfy their basic needs by performing work duties.

In the most approximate sense, such a definition reflects the internal state of a person, however, it should be noted that the forces that impel to action are outside and inside a person and force him to consciously or unconsciously perform certain actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react in completely different ways to the same effects from the same forces.

Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. This is where the concept of motivation comes in. Motivation - an activity aimed at activating the workforce and everyone working in the organization and encouraging employees to work effectively to achieve the goals formulated in the plans.

The function of motivation lies in the fact that it has an impact on the workforce of the organization in the form of incentives for effective work, social impact, collective and individual incentive measures. These forms of influence activate the work of management subjects, increase the efficiency of the entire management system of the organization.

The essence of motivation lies in the fact that, focusing on the system of needs of employees, to ensure complete and effective use their labor potential for the fastest achievement of the goals of the organization.

Labor motivation is the desire of an employee to satisfy needs (to receive certain benefits) through labor activity.

The structure of labor motive includes:

The need that the employee wants to satisfy;

A good that can satisfy this need;

The labor action necessary to obtain the benefit;

The price is the costs of a material and moral nature associated with the implementation of a labor action.

Fig.1. The relationship between the need for work and job satisfaction, attitude to work

motivation medical staff sister

Labor motivation - the most important factor performance, and in this capacity it forms the basis of the employee's labor potential, i.e. the whole set of properties that affect production activities. The labor potential consists of the psycho-physiological potential (a person’s abilities and inclinations, his health, performance, endurance, type nervous system) and personal (motivational) potential. Motivational potential plays the role of a trigger that determines what abilities and to what extent the employee will develop and use in the process of work. Motivation is also the process of creating such conditions that regulate labor relations, within which the employee has a need to work selflessly, since this is the only way for him to achieve his optimum in meeting needs. Motivation is the process of pairing the goals of the company and the goals of the employee in order to most fully meet the needs of both, the process of encouraging oneself and others to work to achieve common goals. Motivation is the creation of conditions for identifying the interests of an organization and an employee, under which what is beneficial and necessary for one becomes just as necessary and beneficial for another [22].

Exist various ways motivations, among which are the following:

1. Normative motivation - inducing a person to a certain behavior through ideological and psychological influence: persuasion, suggestion, information, psychological infection, and the like;

2. Coercive motivation, based on the use of power and the threat of deterioration in the satisfaction of the needs of the employee if he fails to comply with the relevant requirements;

3. Stimulation - the impact is not directly on the individual, but on external circumstances with the help of benefits - incentives that encourage the employee to certain behavior.

The first two methods of motivation are direct, since they involve a direct impact on a person, stimulation is an indirect method, since it is based on the influence of external factors - incentives.

The motivation system can be presented in the form of a special table.

Table 1

Labor motivation system

The main objectives of motivation are the following:

1) Formation in each employee of an understanding of the essence and significance of motivation in the labor process;

2) Training of personnel and management of the psychological foundations of intra-company communication;

3) Formation of democratic approaches to personnel management in each manager using modern methods motivation.

To solve these problems, apply various methods motivation.

Four main methods of motivation:

1. Coercion - is based on the fear of dismissal, punishment.

2. Remuneration - is carried out in the form of systems of material and non-material stimulation of labor.

3. Solidarity - is implemented through the formation of personnel values and goals that are close or coinciding with the values and goals of the organization, and is carried out with the help of persuasion, education, training and the creation of a favorable working climate.

4. Adaptation - implies influencing the goals and objectives of the organization by partially adapting them to the goals of top and middle managers. This type of motivation requires the transfer of authority to lower levels, and this becomes an internal motive that unites the goals of the management and personnel of the organization.

The essence of personnel motivation lies precisely in the fact that the personnel of the enterprise perform their work effectively, each guided by their rights and obligations, in accordance with the decisions of the management of the enterprise.

The types of staff motivation vary slightly among different authors, but it is easy to single out a few basic ones.

Types of staff motivation according to the main groups of needs: material (the employee’s desire for prosperity), labor (the content and working conditions), status (the desire of the individual to take a higher position in the team, be responsible for more complex and qualified work).

Types of staff motivation according to the methods used: normative (influence through information, suggestion, persuasion), coercive (use of the threat of dissatisfaction of needs, coercion, power), stimulation (indirect impact on the personality, benefits and incentives that encourage the employee to the desired behavior).

Types of motives according to the sources of occurrence: internal and external. External motives are external influences, with the help of certain rules of behavior in a team, through orders and instructions, payment for work, etc. Internal motives are influence from within, when the person himself forms motives (for example, knowledge, fear, desire to achieve a certain goal or results, etc.). The latter type of incentive is much more effective than the former, because the work is done better and less effort is spent on it.

Types of personnel motivation in order to achieve the goals and objectives of the organization: positive and negative. Positive - these are personal bonuses and bonuses, the order of the most important work and VIP clients, etc. Negative - these are various comments, reprimands and penalties, psychological isolation, transfer to a lower position, etc., and all types of penalties should be communicated and explained to the whole team, and not just to a specific individual.

Factors of staff motivation can be identified as follows:

1. The need to work in a successful and well-known company. Here the main role is played by the prestige or "branding of the enterprise", when its employees are proud of the fact that they take an active part in the life of the organization.

2. Fascinating and interesting work. The best option when hobby and work are synonymous. If the work activity of an employee allows him to fulfill himself and brings pleasure, then the work of the individual will be successful and effective. The status of an employee, the possibility of his development and the acquisition of new knowledge, his participation in planning the tasks of the enterprise play an important role here.

3. Financial incentives. All types of bonuses, bonuses and, in fact, salary are components of this factor.

It is impossible to change the attitude of people towards work by law, since this is a long evolutionary process, but it can be accelerated if a specific situation is soberly assessed and the reasons that gave rise to it are taken into account.

Managers are always aware that it is necessary to encourage people to work for the organization, but at the same time they believe that simple material rewards are enough for this. In some cases, such a policy is successful, although in essence it is not correct.

People who work in modern organizations are usually much more educated and well off than in the past, so their motivations for working are more complex and difficult to influence. There is no single recipe for developing a mechanism for effectively motivating employees to work. The effectiveness of motivation, like other problems in management, is always associated with a specific situation.

1.3 Factors of motivation for the work of nurses in health care facilities and the main directions for its increase

Motivation of personnel is a key direction of the personnel policy of any enterprise. But not all tools that allow highly effective management of the behavior of employees of commercial companies are also effective in managing medical personnel.

In the health care system, nursing staff is the most significant part of the workforce. The professional activities of nurses are particularly affected by such negative factors as insufficient prestige of the profession, relatively low wages, difficult working conditions, which complicates the management process. In this regard, it is extremely important to clearly motivate the activities of nurses in the changing management structure of medical institutions.

The concept of labor motivation in the economic sense appeared relatively recently. Previously, the concept of motivation was replaced by the concept of stimulation and was used mainly in pedagogy, sociology, and psychology. Such a limited understanding of the motivational process led to an orientation towards obtaining a momentary result. This did not arouse a significant interest of nursing staff in their own development, which is the most important reserve for increasing labor efficiency. Work has ceased to be the meaning of life for many people and has become a means of survival. And in such conditions it is impossible to talk about the formation of a strong labor motivation, about labor efficiency, advanced training of employees and the development of initiative.

In health care, a simple material reward is considered sufficient as the main motivational factor. Sometimes this policy is successful. And since a motive is a conscious impulse to achieve a specific goal, understood by a person as a personal necessity, a need, then the structure of the motive includes, in addition to needs, actions to achieve them, and the costs associated with these actions.

Motivation is represented by motivation and stimulation. If motivation is a process of influencing a person in order to induce him to certain actions by awakening certain motives in him, then stimulation consists in using these motives.

With the development of health care, more and more attention is paid to the motivational function of management, when motivation is preferred over administrative and strict control. Moreover, the most common group of motivating factors is not "carrot and stick" and not fear and disciplinary responsibility, but a group of factors, including trust, authority, reward. Job security and working conditions are of great importance.

Five levels in the system of labor motivation of nursing staff of medical institutions can be represented as a kind of pyramid, at the base of which there is such a component of motivation as the principles of leadership, the remaining components of motivation can have the following arrangement according to the levels of the pyramid (see Fig. 2).

Fig.2. The system of motivation for the work of nurses

The motivations of medical personnel and their actions to achieve certain goals are guided by values that are prioritized. At the same time, studies often refer to the scoring of values.

On the example of one of the medical institutions in Novosibirsk, in 2012, studies were carried out on the distribution of values according to the priorities of nurses (researchers A.I. Kochetov and E.I. Loginova) . As a result of the survey, nurses put forward the first place wages, medical care and job satisfaction. On the second and third place - the respect of colleagues, a good relationship with them, as well as encouragement from the administration. Equally important for nursing staff is the possibility of self-realization, social package and recognition in the organization. The possibility of self-realization in the profession was indicated by 23% of respondents. This indicator is explained by the fact that the functions of nursing staff are more limited compared to doctors. Work is perceived as monotonous. Sisters often perform it mechanically, without delving into the essence of new tasks. Professionalism in a narrow specialization is growing and interest in self-education is decreasing. It should be emphasized that when asked about further cooperation with the organization, 7% of the nursing staff of the medical institution expressed dissatisfaction with the current state of affairs and 22% avoided answering this question. Thus, a survey of nurses showed that about 30% of the staff did not agree to continue working under the same conditions. This suggests that in order to retain staff, changes are needed both in the pay system and in the structure of nursing staff management.

In order to identify preferred types of labor stimulation for nursing staff, the same researchers (A.I. Kochetov and E.I. Loginova) conducted a survey of nurses in one of the clinical diagnostic centers in Novosibirsk. The results of the study showed that 77.5% of respondents preferred financial incentives. Among non-monetary material incentives, nurses preferred the provision of preferential vouchers for rest and treatment (71.5%); improvement of working conditions, workplace ergonomics (66.5%); introduction of flexible working hours (62.5%); providing benefits for paying for departmental housing and utilities (59%); voluntary medical insurance for personnel (44%); organization of subsidized meals (44%). Among the preferred forms of moral encouragement, the majority of respondents noted: careful attention to individual proposals aimed at improving the common cause (69%); gratitude announcement (59%); one-time granting of authority in solving certain production issues (22%).

After analyzing the data on the preferred types of motivation, we can conclude that each individual employee has a motivational system peculiar only to him, which depends on personal qualities person and the life circumstances in which he is currently. It is necessary to strive to focus motivation on values that are of priority for a particular nurse.

The prestige of the profession of a nurse, as noted earlier, plays one of the significant roles in the structure of the labor motivation of nurses. Raising the prestige of a profession is not so easy, and this is a common task not only for the healthcare system, but also for the cultural state of the whole society, the hierarchy of social values. Western-style labor motives and values introduced into the mass consciousness of Russians from the outside do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements for economic development. The decrease in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere.

There is no widespread propaganda of the social significance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture.

Thus, it is possible to determine the main directions of activity of health care managers at various levels of management, aimed at maintaining and increasing the labor motivation of nurses (Table 2).

table 2

The main directions of increasing the labor motivation of nurses

at the level of public administration	at the local government level	at the management level of the organization
1. Increasing the prestige and widespread promotion of the social significance of the nursing profession. Providing recognition to workers and veterans of the profession.
2. Establishing a decent level of remuneration for nurses.	2. Organization of seminars, conferences, competitions at city, district, regional levels, exchange of experience between various medical institutions.	2. Development of a system of additional financial incentives for employees, creation of opportunities for preferential medical care for employees and their families.
3. Equipping medical institutions with modern equipment and introducing modern technologies.	3. Allocation of additional funds for the technical and technological equipment of medical institutions.	3. Development of organizational culture: popularization of the mission, formation of loyalty and commitment of employees of the organization and other specific aspects.
4. Popularization advanced level secondary and higher nursing education.	4. Organization of target sets into higher educational institutions graduates of medical schools and colleges who have shown themselves excellently during their studies.	4. Attention to personnel work: the creation of programs for the adaptation of young professionals, the study of labor motivation of personnel and the creation of motivational programs, etc.
5. Expansion hierarchical structure health care facilities, creating career opportunities and more differentiated pay for nurses.	5. Attracting schoolchildren and students of medical schools and colleges to research work and popularization of medical knowledge, establishing nominal scholarships.	5. Prevention of professional stress and professional burnout syndrome: introduction of a position of a psychologist, training of personnel in anti-stress behavior skills, conducting socio-psychological trainings.
6. Development of load standards and standards for the provision of medical care. Introduction to the staff of health care facilities of the position of HR manager and psychologist.		6. Creation of comfortable conditions at work. Monitoring compliance with safety regulations. Implementation health-saving technologies.
7. Introduction to advanced training programs for paramedical workers of mandatory social and psychological training (at least 24 hours).	7. Wide involvement of highly qualified medical personnel in teaching activities at the advanced training departments of paramedical workers.	7. Development of the nursing process as the main model for the provision of nursing care.

Some of the measures listed in the table are being successfully implemented in the field of domestic healthcare at the present time, while the other part requires its detailed consideration and application.

1.4 Measuring and indicators of job satisfaction of nurses

IN last years pay more attention to the evaluation of customer satisfaction. Interest in this problem is associated with the formation of a client-oriented approach and the creation of a quality management system, which is an indispensable attribute of increasing the competitiveness of a medical institution.

At the same time, insufficient attention is paid to the assessment of staff satisfaction. Meanwhile, the relevance and importance of solving this problem is due to a number of factors. Here are some of them .

Taking into account, within the framework of personnel management, the needs and expectations of its employees in recognizing their activities, job satisfaction, as well as in their development, helps to ensure that they are most motivated, and, consequently, retain qualified employees and attract new ones. High staff satisfaction allows the organization not only to reduce staff turnover, but also to counteract the problem of labor shortage, which today is especially acute in relation to highly qualified specialists who provide key areas of activity of healthcare facilities. The satisfaction of the organization's employees largely determines the degree of satisfaction of its customers.

Thus, in order to improve the organization's policy in the field of personnel management existing standards quality standards recommend conducting a staff satisfaction assessment, which will help form a feedback system with employees.

What is employee job satisfaction? Staff satisfaction with work should be understood as the fact that employees perceive the degree of compliance of the conditions provided by the organization, content, remuneration (and other factors) with the needs and requests of employees, that is, what they consider important.

Table 1

Various forms of job satisfaction

Progressive Job Satisfaction:	The person feels job satisfaction in general. By increasing the level of aspiration, a person tries to achieve even more high level satisfaction. Therefore, "creative dissatisfaction" regarding certain aspects of the work situation may be an integral part of this form.
Stable job satisfaction:	The person feels satisfied with a particular job, but is motivated to maintain a level of aspiration and a pleasant state of contentment. The increase in the level of aspiration is concentrated in other areas of life due to insufficient work incentives.
Satisfaction with work in humility (satisfaction with the work of a resigned person):	The person feels vague dissatisfaction with work and lowers the level of aspiration in order to adjust to the negative aspects of the work situation at a lower level. By reducing the level of aspiration, he is able to achieve a positive state of contentment again.
Constructive job dissatisfaction:	The person feels dissatisfied with the job. While maintaining a level of aspiration, he tries to cope with the situation by trying to solve problems on the basis of developing enough tolerance for frustration, annoyance. In addition, meaningful actions are available to him within the framework of target orientation and motivation, aimed at changing the working situation.
Fixed job dissatisfaction:	The person feels dissatisfied with the job. While maintaining the level of aspiration at a constant level, he does not try to cope with the situation by trying to solve problems. Frustration tolerance makes the defense mechanisms needed to make an effort to solve a problem seem beyond any possibility. Therefore, the individual gets stuck on his problems, and a pathological development of events is not excluded.
Pseudo-satisfaction with work:	The person feels dissatisfied with the job. When confronted with intractable problems or annoying conditions at work and while maintaining the same level of aspiration, for example, due to motivation for a certain kind of achievement or due to rigid social standards, a distorted perception or denial of a negative work situation can result in pseudo job satisfaction.

According to this model, the development of job satisfaction is a three-stage process. Depending on the combination between expectations, needs and motives, on the one hand, and the work situation, on the other, a person forms a certain degree of satisfaction or dissatisfaction with her / his work. In addition, depending on subsequent changes in levels of aspiration and on subsequent problem-oriented behavior (aimed at solving the problem), six forms of job satisfaction or dissatisfaction can develop.

In the case of indefinite dissatisfaction at the first step, i.e. in the case of differences between the actual values of the work situation and the nominal (own) values of a person, this model offers two different results depending on the level of aspiration strength, which corresponds to the second step: a decrease in aspiration or maintaining the level of aspiration. A decrease in the level of aspiration should lead to what is called job satisfaction "in humility, humility." This form of job satisfaction is confirmed by the results of qualitative interviews, during which a lot of people are revealed who adapt to work situations either by reducing their level of motivation to work and aspirations, or by shifting their motivation and aspirations to non-work activity. It can be argued that the high proportion of satisfied workers who participate in this kind of research is due to a more or less large proportion of those who have passively shifted their aspirations far beyond the work situation. Therefore, according to this model, contentment in humility is only one of the three forms of job satisfaction, and must be distinguished from them.

Maintaining aspiration at the same level in case of indefinite dissatisfaction with one's work can result in three forms, of which the most important is pseudo- (or false) satisfaction with work. Previously, it was ignored in studies because the authors doubted the ability to find justifications. This model suggests that the other two forms, fixed and constructive dissatisfaction with work, are closely related to the mastery of other options, the mastery of resources, and problem-oriented human behavior. All these models are relevant variables in this case, "working" at the third stage of development of various forms of job satisfaction. Both fixed and constructive job dissatisfaction seem to depend significantly on well-known features of the organization, such as control or social support at work, in one connection, and on what is briefly called the ability to acquire resources - the ability to use this parameter - in another. Constructive dissatisfaction is obviously an adjunct to job satisfaction in humility.

The model of various forms of job satisfaction points to the lack of a simple quantitative representation, even if this representation is quite complex and includes several aspects, such as work colleagues, working conditions, content of work, promotion, and so on. Therefore, job satisfaction, which we usually think about and traditionally measure, must be differentiated. Presented in the form of stable, progressive and humble job satisfaction on the one hand, and fixed and constructive dissatisfaction on the other, job satisfaction (dissatisfaction) simply can no longer be regarded and used as a product; rather, it should be seen as a process-oriented outcome of the interaction between man and work, dependent to a large extent on the control mechanisms that govern this interaction.

To date, studies using the model of various forms of job satisfaction have led to three important results.

First, the forms of job satisfaction can be, according to this model, reasonably differentiated; while the proportion between forms in different samples may vary, several forms (eg satisfied in humility, constructively dissatisfied) recur in research (Bussing, 1992; Bussing et al, 1997).

Secondly, the forms of job satisfaction depend more on situational factors, for example, the degree of control by the employee of his workplace, than on the disposition of factors.

Thirdly, the forms of job satisfaction do not function like psychological types, that is, they are unstable over a long period of time. Although this model is considered progressive among other models, little is known about the background and consequences associated with various forms of job satisfaction. In addition, there is still a lack of in-depth research comparing this model with other common conceptions of job satisfaction.

The inability to meet the urgent needs of workers through labor activity leads to an increase in the importance of additional ways of "earning money", including the search for other sources of employment, theft, corruption and other negative trends.

Job satisfaction depends on a number of factors, including wages, sanitary and hygienic conditions, the prestige of the profession, employment stability, etc. include the theory of two factors by F. Herzberg, the theory of human relations by E. Mayo and Roethlisberger, the Lawler-Porter model of motivation, and others. Such Soviet sociologists as V. A. Yadov, A. G. Zdravomyslov, and others studied the problem of the attitude of workers to work. At the same time, some researchers note the presence of direct or indirect relationships between staff satisfaction and their loyalty (devotion) to the organization, as well as with the effectiveness of their work. The presence of these links makes it possible to identify the assessment of satisfaction.

Evaluation of staff satisfaction with work contributes to the adoption of balanced, informed decisions by management, for which it is necessary to have reliable, timely, complete information about the state of labor resources in the organization.

For evaluation, you can use a complex of medical and social research methods: sociological (questionnaires), social and hygienic (data from reporting documents), the method of expert assessments. Sources of information about the opinions of employees can be group (for example, a survey of a certain category of personnel) and individual interviews, questionnaires, etc.

You can also determine the structure of motivation and highlight the actual factors of satisfaction or dissatisfaction with work using the Herzberg test.

The causes of dissatisfaction identified through the assessment can be eliminated with the help of management actions available to the organization (for example, referral for training, bonuses, rotation, etc.).

Summing up, we note that in order to increase the level of staff satisfaction (and, thereby, achieve significant advantages for the company over competitors) through the introduction of an organization satisfaction assessment system, the following main steps must be taken.

Step 1. Assess the current level of staff satisfaction (in general, for key employees, etc.).

The personnel survey will allow to determine the level of its current job satisfaction and highlight the most problematic areas, as well as gaps (discrepancies) between the current and desired state.

The necessary components for organizing a survey are the development of a questionnaire, the choice of a method for processing and analyzing the information received, etc.

The assessment can be carried out both independently, with the involvement, for example, of the personnel service, and with the help of third-party organizations professionally engaged in such studies.

Both evaluation methods have their advantages and disadvantages. Assessment of staff satisfaction with work by the organization itself is certainly cheaper in cost. However, in this case, there is a risk of obtaining distorted, unreliable information due to the fact that the employees conducting the survey are deeply involved in industrial relations and are subject to interest in the results of the assessment.

A third party organization not interested in the results of the assessment will be able to conduct an independent survey. The implementation of this option will require certain financial costs, perhaps slightly more than the amount of funds for conducting the survey “in-house”. However, having experience in providing such a service, an external organization will be able to implement it more quickly and efficiently. Thus, at this stage, the involvement of an external organization to conduct the survey seems to be more preferable.

Step 2. Organization of a system for regular monitoring of staff satisfaction with work and the use of information to make informed management decisions in the field of personnel management.

Conducting staff satisfaction surveys at regular intervals will help to early stage prevent the occurrence possible problems. Thus, it will allow the organization to retain key employees. Expenses for conducting surveys pay off with significant savings Money and time for the selection, training and adaptation of new employees.

At this stage, it is advisable to shift the main focus of the work to the service of the personnel of the organization itself, outsourcing only some functions or business processes (for example, assistance in organizing the system, designing the distribution of functions between structural divisions, preparing drafts of the necessary regulations, methodological and information support ).

Step 3. Improving the system of regular monitoring (seizing opportunities to improve HR activities)

Taking into account the changes taking place in the external environment and in the organization itself, it is necessary to improve the assessment methodology (for example, change the survey questionnaire, sample, etc.), methods of information analysis, etc. This will bring the tools used for assessing satisfaction in line with current requirements organizations for more accurate results.

It seems that the main activities of this stage should be entrusted to a third-party organization that can professionally conduct an audit. existing system assessment of staff satisfaction and develop the necessary recommendations for its improvement.

Finishing the first theoretical chapter term paper, the following conclusion can be drawn.

Bibliography

1. Alekseeva O.D., Solovieva A.V. The role of the head of the nursing service in creating a "motivational" environment of the institution // Medical sister. - 2008. - No. 4

2. Antipova I.N., Shlykova I.N., Matveeva E.V. Management of motivation of labor activity of medical nurses of healthcare facilities // Chief Nurse. - 2010. - No. 6.

3. Bochkarev A.A. Labor motivation as a problem of social philosophy [Electronic resource]: Dis... candidate of philosophic sciences: 09.00.11. - M.: RSL, 2005

4. Butenko T.V. Mental burnout and work motivation of nursing staff [Text] // Young scientist. 2010. No. 11. - S. 157 - 161.

5. Butenko T.V. Work motivation of nurses: problems and prospects for solutions [Text] / T. V. Butenko // Psychological sciences: theory and practice: materials of the international. in absentia scientific conf. (Moscow, February 2012). - M.: Buki-Vedi, 2012. - S. 72-75

6. Vesenin V.R. Practical personnel management: a manual on personnel work / V. R. Vesnin. - M.: Yurist, 2007. - 495 p.

...

Four main models of nursing care

1. Evolutionary-adaptive model

The patient is seen as a person and an individual.

Source of problems: changes in the patient's life associated with past or future events, especially during periods of crisis.

Main tasks: the nurse acts as a mentor-coordinator, providing assistance to the patient during critical periods of life, when there is a threat to human health.

Focus of intervention: assistance to the patient during the period of adaptation to the changed environmental conditions; help in overcoming the crisis period of life.

Methods of intervention: various methods of stimulating the patient.

Expected results: adaptation of the patient's health to crisis changes.

2. The patient as a behavioral system

Source of problems: emotional and functional stress.

Main tasks: the nurse acts as a controller and regulator, ensuring the balance of the emotional and functional state of the patient.

Focus of intervention: mechanisms of regulation and control that ensure the stability of the patient.

Methods of intervention: prevention, protection, relaxation of a patient prone to unstable disorders.

Expected results: an adequate response of the patient to the stressful conditions experienced.

3. Adaptation model

The patient is seen as a person who is constantly adapting to the conditions of the external environment.

Source of problems: lack of activity on the part of the patient, showing passivity to the disease.

Main tasks: the nurse acts as a teacher-organizer who must teach the patient how to adapt to changing environmental conditions.

Focus of intervention: stimulation of the patient to learn to adapt to environmental conditions.

Methods of intervention: the use of stimulation of the patient.

Expected results: complete adaptation of the patient due to the stimulation to adaptation.

4. Self-care deficit model

The patient is seen as having problems with self-care.

Source of problems: the inability of the patient to provide competent and full-fledged self-service.

Main tasks: the nurse acts as a controller and teacher, who is obliged to teach the patient the methods of self-care.

Focus of intervention: dysfunction of self-care in a sick person.

Methods of intervention: assistance and assistance in self-service.

Expected result: stabilization of the patient's ability to self-care and self-care.

It is certainly good that modern nursing no longer refers to outdated patterns of behavior, but forms new, more relevant forms of interaction and assistance to the sick and injured, based on the conditions of today's healthcare system and other real factors.

SOCIO-PROFESSIONAL COMPETENCE AND MOTIVATION OF NURSING ACTIVITY OF AVERAGE MEDICAL PERSONNEL

Graduate work

Specialty - Nursing

Introduction ..............

Chapter 1 Literature Review

1.1 The concept of "motive" and "motivation" in psychology ..............................

1.2 The influence of the motivation of specialists on the effectiveness of their professional activities..................................

1.3 Features of the motivation of nursing staff ...

Chapter 2 Object and methods of research ..........

Chapter 3. Results of own research

3.1 Socio-professional characteristics of the nursing staff of the Central Medical and Sanitary Unit No. 1 of the Federal Medical and Biological Agency of Russia in Baikonur..........

3.2 Motivation of the professional activity of nursing staff ..........................................

3.3 Socio-professional competence ...............................

Conclusion........................

Bibliography........................

Application................

INTRODUCTION

An important link in the healthcare system is the category of paramedical workers, the qualifications of which determine the success of the medical institution.

Since the success of the institution's activities is closely related to the skills of personnel management, the principles of the relationship between the leader and subordinates are currently changing dramatically.

Human resource management includes many components. Among them: personnel policy, relationships in the team, socio-psychological aspects of management. The key place is occupied by the definition of ways to increase labor productivity, ways of increasing creative initiative, as well as stimulating and motivating employees.

No management system will function effectively if an effective model of motivation is not developed, since motivation encourages a particular individual and the team as a whole to achieve personal and collective goals.

Leaders have always been aware that motivational aspects are becoming increasingly important in modern management. Motivation of personnel is the main means of ensuring the optimal use of resources, mobilization of existing human resources.

The main goal of the motivation process is to get the maximum return from the use of available labor resources, which allows to increase the overall performance of the medical institution.

A feature of nursing staff management is the growing role of the personality of a medical worker. Accordingly, in the healthcare system, there is a qualitatively different ratio of motives and needs, on which the motivation system can rely. Today, both financial and non-financial methods of remuneration are used to motivate employees of healthcare institutions. Meanwhile, neither the theory of management nor the practice of personnel management gives a definite picture of the relationship between individual aspects of the motivational sphere of medical personnel today and the most effective methods of managing them.

Purpose of the study- to identify the relationship between the characteristics of the motivational sphere of nurses and the results of their professional activities

Research objectives:

1. To give a comprehensive socio-professional description of the nursing staff of the Central Medical and Sanitary Unit No. 1 of the Federal Medical and Biological Agency of Russia in Baikonur (TsMSCH No. 1 of the FMBA of Russia);

2. To study the motivational aspects of the professional activity of the Central Medical School of Medicine No. 1 of the FMBA of Russia.

CHAPTER 1 LITERATURE REVIEW

1.1 THE CONCEPT OF "MOTIVE" And " MOTIVATION" IN PSYCHOLOGY

There are two functionally interconnected sides in human behavior: incentive and regulatory. Motivation provides the activation and direction of behavior, and regulation is responsible for how it develops from beginning to end in a particular situation. Among all the concepts that are used in psychology to describe and explain the motivating moments in human behavior, the most general and basic are the concepts of "motivation" and "motive".

Motive (from lat. moveo - I move) is a material or ideal object that induces and directs an activity or act and for which they are carried out. The development of the motive occurs through a change and expansion of the range of activities that transform the objective reality. In man, the source of motive development is the process of social production of material and spiritual values. Such potential motives in ontogeny are the objective values, interests and ideals inherent in a given society, which, if internalized by a person, can acquire motivating force and become really effective motives.

A motive is something that is inside a person and makes a person move, realize his potential.

Motivation - impulses that cause the activity of the organism and determine its direction. If we study the question of what the activity of the organism is aimed at, for the sake of which the choice of these particular acts of behavior, and not others, is made, we study, first of all, the manifestations of motives as the reasons that determine the choice of the direction of behavior. Until now, the category "motivation" by various psychological schools in modern psychology is used in a double sense: as denoting a system of factors that determine behavior (needs, motives, goals, intentions, aspirations, etc.) and as a characteristic of a process that stimulates and supports behavioral activity. at a certain level. VK Vilyunas defined motivation as a set of psychological causes that explain human behavior, its beginning, direction and activity.

In his studies of behavior, A.N. Leontiev came to the conclusion that it can be explained by both internal and external causes. In the first case, these are motives that characterize the needs, intentions from the current situation. All psychological factors that, as it were, from within, from a person determine his behavior, are called personal dispositions. Based on this, dispositional and situational motivation is distinguished as an analogue of the internal and external determination of behavior. “Dispositional and situational motivation are not independent. Dispositions can be actualized under the influence of a certain situation and, on the contrary, the activation of certain dispositions (motives, needs) leads to a change in the situation, its perception by the subject, whose attention becomes selective, and the subject himself perceives and evaluates the situation biased, based on actual interests and needs. Almost any human action is doubly determined: dispositionally and situationally.

One of the most famous models of motivation belongs to A. Maslow, who proposed to consider the main motivation of a person as a hierarchy of five levels: 1) physiological needs - the need for oxygen, water, food, physical health and comfort; 2) the need for safety and security - the need for protection from danger, attack, threat; 3) the need to belong to a social group - the need for good and loving relationships with other people; 4) the need for respect and recognition - the need to feel valued by others and by oneself; 5) the need for self-actualization - the need to develop and realize one's full potential. Orientation towards oneself reflects not only the two lower levels of the pyramid, but also its highest level, its top - the desire for self-actualization. A. Maslow identifies special groups of cognitive and aesthetic needs. Cognitive needs (in cognition and understanding), its representation serve to satisfy basic needs, and a clear differentiation of aesthetic needs is not yet possible. In accordance with the concept of A. Maslow, a person must first satisfy the needs of more low level so that it can begin to meet the needs of higher levels. But a person is driven by the higher needs: “ Healthy man is motivated mainly by the need to develop and actualize to the fullest extent their potential and abilities. If a person actively manifests other basic needs, and even in a chronic form, then he is simply an unhealthy person. He must be ill, as if he had developed an acute deficiency of salts or minerals. “However, the rule of successive transition from the lower levels of the hierarchy to the higher ones has not received empirical confirmation. As a result of the research, questions arose: 1) whether the satisfaction of needs really ceases to be active; 2) whether the satisfaction of the needs of one level activates the needs of the next level; 3) can't people be motivated simultaneously by the needs of several levels, for example, social needs, the needs of self-esteem and self-actualization? A. Maslow himself later answered the third question: “Practically any behavioral act is determined by a variety of determinants or a variety of motives. If we talk about motivational determinants, then behavior, as a rule, is determined not by one single need, but by a combination of several or all basic needs.”

A.L. Sventsitsky writes: “Our idea of the hierarchy of needs will be more realistic if we introduce the concept of a measure of needs satisfaction and say that lower needs are always satisfied to a greater extent than higher ones. For an average citizen, physiological needs are satisfied, for example, by 85%, the need for security is satisfied by 70%, the need for love is satisfied by 50%, the need for self-esteem is 40%, and the need for self-actualization is 10%. The term "measure of meeting the need" allows us to better understand the thesis of the actualization of a higher need after the satisfaction of a lower one. The process of actualizing needs is not sudden, not explosive; rather, one should speak of a gradual actualization of higher needs, of a slow awakening and activation. For example, if need "A" is satisfied only by 10%, then need "B" may not be detected at all. If need "A" is satisfied by 25%, then need "B" is "awakened" by 5%, and when need "A" receives 75% satisfaction, then need "B" can reveal itself by all 50%, etc. e. "Attempts to experimentally confirm A. Maslow's concept did not lead to a definite answer. A. Maslow's approach is very common and influential among personnel managers.

As A.N. Leontiev pointed out, in modern psychology the scope of the concept of “motive” remains unclear: “... in a motley list of motives one can find such as life goals and ideals, but also such as irritation electric shock". In this regard, two categories of phenomena are distinguished: the actual motives of the individual and the entire set of “dynamic forces” or “psychological moments” that, along with motives, determine the holistic behavior of a person. In the second of these cases, the motive is understood as a formal term that does not have its own meaning and serves to designate completely heterogeneous phenomena that in one way or another stimulate and direct human activity. This trend can be traced in the works of such domestic psychologists as V. G. Aseeva, L. I. Bozhovich, V. I. Kovalev, A. N. Leontiev, and others. .M. Teplov indicate that needs are the initial motives of human behavior, but far from the only ones: “Feelings, interests and inclinations play a very important role in motivating our actions, and, most importantly, our worldview, our views and beliefs, our ideals to which we subordinate our behavior. According to P.M. Yakobson, motives can be political, moral ideals, ideas about the future, about the future; sufficiently effective interests to receive impressions; the desire to organize life and life, the attraction to work, creative activity, to family life and so on.; strong need for something a strong enough feeling; effective moral convictions; habits; imitation.

VG Aseev calls needs, drives, goals, interests as the main forms of motivation. An essentially similar view is formulated in the works of B.F. Lomov, where the motive is interpreted as a reflection of a need, and desire, a sense of duty, interest, incentive, etc. - as possible forms of a reflection of a need.

The broad interpretation of the concept of "motive" is especially characteristic of Western psychology. G. V. Allport, based on the idea put forward in 1918 by R. S. Woodworth about the transformation of the mechanism of behavior into its motivation, formulated the idea of functional autonomy of motives. Opposing the reduction of the various motives of a mature personality to several, sometimes even to one or two, primary instincts, desires or needs, G.V. Allport wrote: “Neither four desires, nor eighteen inclinations, nor any of their combinations, or even all of them together taken, with all possible additions and variations, cannot adequately explain the infinite variety of goals pursued by the infinite multitude of mortals. Based on the analysis of life observations, as well as on experimental and clinical data, G.V. Allport came to the conclusion that any action, initially subordinated to some specific goal and serving only as a mechanism for achieving it, can turn into a motive that has an independent motivating force. . The main condition for such a transformation, or transformation, of motives is the imperfection of the action that served as a means to achieve the original goal. The motives are "talent in the stage of improvement and skill in the stage of formation." Motives, according to G.V. Allport, are always a kind of striving for completion, they are not discharged tension, which should “lock in” on current activity. As an experimental confirmation of his theory, G.V. Allport cites, in particular, the effect of B.V. Zeigarnik, established in 1927 in a series of studies by K. Levin. In the studies of the school of K. Levin, the concept of "motive" was not specifically included in the system of basic concepts. The motivational sphere of personality was described by such concepts as "need", "quasi-need", "intention" and "tension". As B.V. Zeigarnik points out, K. Levin understood the quasi-need to be a dynamic state (activity) that occurs in a person when an intention is carried out. K. Levin separated quasi-need from stable, in his words, “true” needs, although he emphasized that in its structure and mechanisms, quasi-need does not differ from true needs: “... the tendency to cause action is fundamental for need. This property of a need or a quasi-need can be represented in the coordinates of a "tense system"... Correlation of the "discharge of tension" with "need satisfaction" (or "goal achievement"), and the "appearance of tension" with "intention" or "need in a state of dissatisfaction" "allowed to draw a large number of verifiable conclusions." Formally, the dynamic approach, which appeals mainly to energy (tense system) or vector-opological characteristics of motivated behavior, significantly narrows the scope of the conclusions obtained in the studies of K. Levin's school. According to V.G. Aseev, this area is limited by diffuse impulses of the lowest structural-genetic level.

Synonymous with the term "motive" are a variety of terms: "psychogenic need"; "quasi-need" or simply "need". J.Atkinson interprets the motive as a fairly stable personal characteristic, as a kind of “normative state”, opposed to the state of an actually acting motive, or actual motivation. In the works of H. Heckhausen, a clear distinction is made between the concepts of "potential" and "real" motivation. Potential motivation is considered as a peculiar structure of value orientations, which, as a frame of reference, determines the desirability or undesirability of this or that state for a given person. Real motivation is, as it were, a “motivational moment”, i.e. a situational state of motivation, a state of an “awakened” motive. A similar division is carried out in the Georgian School of Psychology, such authors as A.S. Prangishvili, D.N. Uznadze, A. Mehrabyan, the concept of "motive" is considered as a transient state that prompts action and disappears after the satisfaction of the corresponding need. The installation, on the contrary, is interpreted as a long, permanent state of unity of the motivating and guiding moments of activity, as a long-term readiness to activate a definitely motivated activity. The difference in the interpretation of the Georgian school from the interpretation of J. Atkinson and H. Heckhausen, no less, lies in the fact that in the theory of installation, the motive denotes a variable component of motivation, and in the interpretation of J. Atkinson - a constant component.

SL Rubinshtein interprets the motive as a conscious (conscious) motivation for a certain action, which has become the direct cause of human actions in the outside world. Motives, as well as needs, can be characterized by varying degrees of awareness. A.N. Leontiev generally considered awareness of motives to be something secondary, initially not given, requiring special inner work: “... motives are not actually realized by the subject; when we perform certain actions, then at this moment we usually do not realize the motives that prompt them. True, it is not difficult for us to give their motivation, but the motivation does not always contain an indication of their real motive. The existence of unconscious, or unconscious, motives is an experimentally proven fact. They appear in studies of perception, attitude, thinking, artistic creation, normal and hypnotic sleep, and so on. In the psychoanalytic tradition, the unconsciousness of motives is a sign of the incompatibility of the repressed motives and impulses with the image of the social, well-controlled "I". The scale of the unconscious is unknown. The forces that move us from these depths can be anything.

Here we point out that in the theoretical foundations, when considering the issue of motives, motivation, the emphasis is on incentives, incentives, people's needs, rewards. Motivation and stimulation are two different things. A motive is something that is inside a person and makes a person move, realize his potential. An incentive is something that is outside, stimulating a person or a group of people to activate this or that activity, occurs to achieve the goal of the organization, to solve a particular problem. Needs are what we don't have. Awareness of the lack of something, causing an impulse to action. Needs are primary, elementary, they are laid at the gene level, have a physiological basis. Unfortunately, nothing can be done about them. Secondary needs arise as necessary, as a person lives and gains life experience. The remuneration is external, it is a remuneration in style: salary, various payments, paid meals, medical care, social benefits, loans, promotion. And there is an internal reward - that which the work itself gives directly. A sense of success in achieving a goal, a sense of self-worth, pleasure in the end.

Theories of motivation to work are divided into two groups: 1) content theories, 2) process theories.

The former emphasizes the study and explanation of what motivates and what are the motives for certain behavior. The latter elucidate the process that promotes the process of motivation that takes place within a person. To really be able to understand motivation as a phenomenon, both concepts are needed, as well as a personal approach to consideration.

The most common "Maslow's Theory". Abraham Maslow was the first to prioritize basic needs, put them in a certain hierarchy. Maslow's classification presents us with the following needs: - physiological (thirst, hunger, sleep, sexual), - need for security (predictability, clarity of life), - social needs (love, belonging to a certain social group), - need for respect (self-esteem, success, status), - the need for self-expression. Maslow argues that the strongest need determines behavior until it is satisfied. A satisfied need no longer determines behavior, that is, it does not act as a motivating factor.

Needs are met in a certain order. Physiological needs and the need for security are primary needs that must be satisfied before higher-level needs can determine behavior. According to Maslow, if there are two equally strong needs, then the need of a lower level dominates.

Thus, the conditions and the situation, for their part, determine which needs will dominate. The needs associated with the respect of the individual and in this sense are individual. Therefore, in the same situation, different people may have different needs, and a change in the situation entails a change in the needs of one person. It is important that Maslow said that the levels of needs can overlap to a certain extent. A person can be driven by lower level needs, even when he has higher level needs. Work as such can provide an opportunity to meet needs. In this case, often we are talking about higher-level needs related to respect and self-expression. On the other hand, work can be a way to find opportunities to meet such needs outside of work, and then higher-level needs associated with conditions and safety factors dominate.

Another theory that still works today is called Herzberg's Two Factor Theory of Motivation. This theory was created on the basis of interview data taken in various workplaces, in various professional groups and in different countries. If Maslow proposed one hierarchy in the form of a pyramid, then Herzberg made two axes directed in different directions. He analyzed how people relate to their work. Studying the collected material, Herzberg came to the conclusion that job satisfaction and dissatisfaction are caused by various factors.

Job satisfaction is affected by:

Achievements (qualification) and recognition of success,

Work as such (interest in work and task),

Responsibility,

Career advancement,

Opportunity for professional growth.

These factors he called "motivators". The more such factors, the greater the motivation.

Job dissatisfaction is influenced by:

control method,

Organization policy and administration,

Working conditions,

interpersonal relationships in the workplace,

earnings,

Uncertainty about work stability

The impact of work on personal life.

These external factors are called "factors of the complex", or "hygienic".

Motivators that cause job satisfaction were associated with the content of the work and were caused by the internal needs of the individual in self-expression. Factors causing job dissatisfaction were associated with job deficiencies and external conditions. With these factors it is easy to associate unpleasant sensations that must be avoided.

According to Herzberg, the factors that cause job satisfaction are not opposites in the same dimension. Each of them is, as it were, in its own scale of measurements, where one operates in the range from minus to zero, and the second - from zero to plus. If contextual factors create a bad situation, then employees experience dissatisfaction, but at best these factors do not lead to great job satisfaction, but rather a neutral attitude.

Job satisfaction is caused only by motivational factors, the positive development of which can increase motivation and satisfaction from a neutral state to a “plus”.

Popular is Vroom's Expectation Theory, where motivated activity is purposeful. The goal is usually associated with the direct or indirect satisfaction of a need. The strength of the direction of activity towards achieving the goal depends on the extent to which the person feels rewarded for achieving the goal. The strength of the desire for a reward or other goal (in other words, performance motivation) depends on the value of the reward (desirability) and its achievability (the reality of receiving a reward, "the value of expectations").

What a person values depends on his needs. In order for a person to be motivated for a certain activity, his achievements in this activity must be rewarded with what he values, and the reward must be associated with the achievement of the goal so that the person notices it. On the other hand, everyone knows that even persistent efforts do not always guarantee the achievement of the goal. On the basis of previously gained experience, an idea (expectation) is formed about how real the possibility of achieving the goal is. In this case, all the possibilities and obstacles that arise due to the environment and the situation of the moment are also weighed.

If expectations are high, the strength of the incentive motive increases. Previous successful experience also reinforces the expectation that an appropriate result could be obtained. Thus, success enhances motivation. If expectations are not met, obstacles to achieving the goal give rise to a feeling of futility of efforts. The greater the importance (value) of an unachieved goal for a person, the greater the feeling of futility. The next time, perhaps, the level of the goal will be slightly lowered, and if it is not realized several times, the assessment of the reality of its achievement will decrease and the motivation will decrease. Feelings of futility reduce motivation, and low motivation reduces performance input, makes it harder to achieve goals, and creates even more feelings of futility. The circle closes.

Setting realistic goals, bringing expectations closer to reality, and rewarding the achievement of the goal in a way that the employee himself values can relieve the feeling of futility.

So, general motivation, in Vroom's words, depends very much on the hope of a fair reward and on the expectation that the work will succeed, succeed; from the fact that the result will be noticed and rewarded, and that this reward will bring satisfaction to the employee, will be really valuable for him.

Also, from the point of view of psychologists in our country, you need to know and apply the “Theory of Justice by D. Adams”. The theory itself says that a person, if he performs conscious actions, compares the proportion: his own reward divided by his own efforts and, as it seems to him, the reward of others, divided by, as it seems to him, the efforts of others. If this proportion is equal to each other, it is considered that the system works fairly. Yes, he gets more because, in my opinion, he works more.

If this proportion is not equal, then the system in this case is considered inefficient and not fair.

MacGregor's XY Theory is considered useful. This theory defines two polar points of view, two views on a person.

Theory X says that humans are actually lazy. The average person works as little as possible, lacks ambition, dislikes responsibility, prefers to be led. A person is by nature indifferent to the needs of the organization, the main thing for him is his own "I". He resists change, most of the time he's easy prey for the demagogue because he doesn't want to work, he's gullible, not too smart. The average person, according to Theory X, is inherently hostile to work. When working with people X, the carrot and stick method is used.

The other pole is this theory Y. A look at a person as a rather active being. People are not naturally passive - this theory says - they do not oppose the goals of the organization. If people are passive and are, they become so as a result of working in this organization. People love to work in an interesting job that gives them the opportunity to develop, take responsibility, direct their efforts towards achieving a visible, clear goal. An important task of managing people is to create such conditions in the organization and apply such methods of working with people so that they can achieve their own goals and common ones. MacGregor said that a person becomes what he is because he is treated that way, that is how he is perceived.