Abstract
Background: Nurse’s engagement is associated with positive outcomes, such as improved staff morale. This, in turn, motivates nursing staff to achieve organisational goals that elevate patient care. However, few studies have been conducted on this subject within the nursing staff of South Africa’s public sector.
Aim: The study explores the correlation between staff morale and engagement, though correlation doesn’t imply causation. Further research is needed to determine any causal relationship.
Setting: The study was conducted in the public health sectors in South Africa in six provinces; namely, Western Cape, Northern Cape, Eastern Cape, KwaZulu-Natal, Free State and North West as per the approval received from each province.
Methods: A quantitative methodology, using self-administered questionnaire from validated instruments consisted of measuring scale developed by Gallup (2006) and the scale developed by Nolan, Brown, Naughton & Nolan (1998). The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 24. Pearson correlation analysis was used to test for relationship between employee engagement and staff morale.
Results: Employee engagement, including compensation, career growth, and work environment, was discussed. For staff morale, rewards, recognition, and job satisfaction were explored. The study found a significant relationship between employee engagement and staff morale.
Conclusion: This study suggests that nursing management foster a supportive work environment and provide sufficient resources to boost nurse engagement and morale.
Contribution: The study will help management understand factors affecting nursing staff engagement and morale, and guide with improvements.
Keywords: nursing staff engagement; nursing staff morale; employee engagement; staff engagement; nursing management.
Introduction
Nurses are the largest group of healthcare providers in the country. The performance of any healthcare system is directly dependent on the quality of care offered by these healthcare professionals. In 2015, a report by the University of the Witwatersrand revealed that over 60% of nurses reported that they felt too tired to work while on duty (MoneyMarketing 2016). This report depicts the profession of nursing in crisis and this has alarming implications for the level of patient care provided. According to the 2030 Human Resources for Health Strategy, there were 71 707 professional nurses, 31 039 enrolled nurses and 33 821 nursing assistants in 2019 in South Africa. The overall density was 282 per 100 000. According to a forecast from the South African Nursing Council (SANC), the number of nurses will decrease somewhat in 2020.
Staff morale refers to an individual’s overall perception of the workplace, which includes emotions, attitudes, outlook and degrees of satisfaction (Ouma 2017:308). It is the outcome of working circumstances and attitudes, not the cause. Good morale leads to optimistic, confident and satisfied staff, whereas low morale can be detected in negative, angry and uncaring staff who fail to sustain productivity and safe company procedures (Ramachandran & Shibu 2017:34).
Whiteoak (2020:960) stated that the link between employee morale and engagement are highly positive. Low morale was a strong predictor of psychological discomfort, while employee engagement was a predictor of employee turnover. He further stated that morale may provide further insights into employee behaviour beyond simply assuming that higher morale means more engaged employees. Morale influences the well-being of employees, impacting the quality of employee workplace performance, labour productivity, quality of work life, and, eventually, profitability of the organisation (Mabindisa & Legoabe 2021:87).
Purpose of the study
This study aimed to explore the relationship between employee engagement and staff morale among nurses in the public sector in South Africa.
Literature review
Theoretical framework of the study
The study utilised the job demands-resources (JD-R) theory to assist in explaining employee engagement (Bailey et al. 2017:36) and to explore the relationship between employee engagement and staff morale. According to Besthelsen, Hakanen and Westerlund (2018:2–3), the JD-R theory’s central tenet is that all aspects of psychosocial work may be divided into demands and resources. The researchers also state that job demands are defined as those elements of a job that require prolonged physical and/or psychological effort (such as workload or role conflicts). In contrast, workplace resources (such as social support and job autonomy) refer to elements of the job that may lessen demands and the physiological and psychological costs associated with those demands.
Employee engagement
Employee engagement refers to the extent to which an organisation captures an employee’s mind and heart thus helping organisations to perform better (Abarantyne, Naidoo & Rugimbana 2019:2). In other words, employee engagement refers to the energy, involvement and positive interaction of an organisation by their employees. Son and Kim (2021:4288) defined employee engagement as the degree to which employees feel connected to the organisation and are free to use their discretion in executing tasks and making decisions.
Ilyasa and Ramly (2018:59) attest that employee engagement is an emotional attachment to the job and organisation, motivation and provision of the best abilities of success of a series of clear benefits for the organisation and individuals. According to Amah (2018:3), employee engagement results from positive working relationships, which are influenced by organisational leaders’ actions.
Factors affecting employee engagement
What motivates employee engagement has been the subject of several recent research. The factors that affect employee engagement may vary depending on an individual, an organisation, and a culture (Al-Saadi 2017:16). In this study, the researcher focussed on the following drivers of employee engagement:
Compensation: Research by Harley (2019:21) suggests that compensation is the glue that keeps a worker and an organisation together. Compensation, which a firm bestows upon its personnel, reflects the dedication and an organisation’s determination to keep its employees. Compensation is viewed as a convincing basis for an employee to stay and be loyal in their organisation. Employees can actively enhance their own work attitudes by using the remuneration they receive at work, which is utilised as a technique of attracting talent (Venzs, Pundt & Sonnentag 2018:30). A good organisation must have a good compensation management system and be able to increase employee engagement in the organisation (Robianto, Masdupi & Syahriza 2020:738).
Career growth opportunities: Employees anticipate working in a learning atmosphere where they can advance their professions through educational opportunities and make more money (Magagula, Maziriri & Saurombe 2020:6; Saurombe & Barkhuizen 2020:88). This means that career development is very important in any company or organisation that aims at progressing to achieve their goal. Deas and Coetzee (2021:320) asserted that employees anticipate being challenged to go beyond the call of duty. This broadens their knowledge so they can excel at their current employment while advancing their careers in their chosen fields. The career advancement attained by staff members shows the attitude valued by the firm, which entails meeting personal development needs and realising one’s own worth (Weer & Greenhaus 2020:289).
Work environment: Employee engagement can rise in a supportive workplace, increasing employee attachment to their jobs. Giving employees a sense of worth and belonging, making sure that their needs are met and being supportive of their viewpoints are all effects of creating a friendly work environment and showing compassion for employees. Employees are urged to develop new abilities (Judeh 2021:224). Soliman and Wahba (2019:78) mentioned that employee engagement can be achieved when employees actively seek significance in their job and share a sense of destiny. The authors further state that in an enabling and supportive environments, workers are engaged and inspired to go above and beyond the call of duty.
Staff morale
Staff morale is defined as a combination of employees’ feelings, attitudes and emotions that results in behaviour at work and influence the success of the organisational goal (Khumalo 2022:58–59). Whiteoak (2021:960) also defines staff morale as a constructive construct that combines feelings of vigour and passion for completing important tasks. The level of employee satisfaction with their jobs and workplace environments is known as staff morale. In addition, the workplace environment, the variables and the satisfaction that the employee derives from their work truly contributes to personal fulfilment (Noor & Ampornstia 2019:141).
Masilela (2018:11) believes that staff morale is the complete attitude, satisfaction and contentment of the organisation’s employees that is traditionally linked to productivity increases; hence, employees who are content are more positive and can perform well. Mabindisa and Legoabe (2021:88) confirm that employee reactions to the workplace, as well as their interactions with co-workers and managers, all contribute to staff morale. They further state that workers’ morale turns into a condition of motivating drive when people or groups feel confident in their capacity to meet objectives and face the future.
Factors affecting staff morale
Staff morale is a complicated issue that depends on a variety of variables. The following are the factors that have been identified for the research study:
Supervisors: Good leadership in work organisations determines staff productivity and will be heavily influenced by how effectively the manager or supervisor employs the workforce (Sudiarta 2021:53). Ravichandran and Balakumaran (2019:1111) concur that supervisors must do good things and be more engaged with co-employees when they are not focussed on their own interests and instead assist with the morale of other employees.
Working environment: According to Masilela (2018:14), employee morale is also affected by the work tools used to carry out the work, such as machine conditions, tools used, medical aid and occupational safety policies. He further adds that if the organisation does not recognise employee loyalty, dedication and hard work, that affects their morale. Mallik et al. (2019:3290) express that any organisation’s work conditions and appearance affect the employees’ state of mind. Zhenjing et al. (2022:3) state that employees prefer to work in settings where they are at ease in their surroundings.
Job satisfaction: According to Babua (2020:30), employee compensation, work, promotion, attitude towards the organisation and relationships with co-workers are all related to job satisfaction. Consequently, having a positive outlook on these elements can improve job satisfaction and raise employee morale. Arun and Agalya (2020:1170) believe that job satisfaction provides employees with a fair chance to determine abilities and build their identity. The employee will conform and have high morale. The opportunity to share benefits remains one of the necessities of the likelihood for high spirits and the chance of advancing issues. Silitonga et al. (2020:90) further add that employment satisfaction affects workplace organisational commitment, increasing staff motivation to attain organisational goals.
Employee engagement and staff morale
Pattnaik and Jena (2020:13) state that mindfulness is a key element for engaging an employee, and in turn also boosts staff morale to enhance employee performance at this perilous time. John (2021:3224) adds that psychological capital influences employee engagement and employee morale. Whiteoak (2021:960) states that staff morale and employee engagement are highly positively correlated. Employee engagement and morale are both superior predictors of psychological discomfort and employee turnover, respectively. He goes on to say that morale may offer further insights into employee conduct beyond just taking it to suggest that employees are more engaged (Mabindisa & Legoabe 2021:87).
Dash and Mohanty (2019:35) are of the opinion that the largest proponents of employee engagement typically define it as a greater degree of staff morale in which workers have a strong sense of loyalty to their organisation and are willing to go beyond what is expected of them. Employee engagement, then, results from having strong staff morale.
Research methods and design
Study design
The study used quantitative research method and used a survey to collect from nurses employed by public health sectors in six provinces. This method used the structured survey questionnaire to collect the required data for the study.
Setting
The study was conducted in the public health sectors in South Africa in six provinces; namely, Western Cape, Northern Cape, Eastern Cape, KwaZulu-Natal, Free State, and North West as per the approval received from each province.
Study population and sampling strategy
The population for this study comprised 108 600 nurses employed in the public health sector across all nine provinces in South Africa. A representative sample of 461 nursing staff in six provinces was drawn through a proportionate stratified random sampling method. The stratified random sampling in this study consisted of nursing staff registered at the SANC employed in the public health sector in South Africa in six provinces, namely Western Cape, Northern Cape, Eastern Cape, KwaZulu-Natal, Free State, and North West in all levels that is Auxiliary Nurses, Staff Nurses and Professional Nurses.
Data collection
The self-administered survey questionnaire from previously validated instruments consisted of measuring scale developed by Gallup (2006) and the scale developed by Nolan et al. (1998) and consent forms were distributed to the nursing staff working in public hospitals in the approved provinces electronically on a monkey survey through their human resource office to be distributed to their nursing staff, which they had to complete and send back to the researcher. However, to address the problem of those employees who do not have access to computers, the researcher agreed with the departments to make the questionnaires available to those nursing staff.
The hard copies of the questionnaire were printed and delivered to the approved provinces for employees who do not have access to a computer. For this purpose, the envelopes were provided for the nursing staff to complete their questionnaire and put them in the provided envelopes and seal them. All manually completed questionnaires received by the provincial and head offices were couriered back to the researcher and/or collected by the researcher in person from time to time until there were no longer any outstanding responses.
A total of 500 questionnaires were printed and delivered and a total of 246 were received back, the remaining of 215 were received electronical. The response rate thus was 57.6% (n = 461).
Data analysis
The collected data were analysed using Statistical Package for the Social Sciences (SPSS), Version 24.0 (Armonk, NY: IBM Corp). Descriptive statistics were applied to create frequency tables, which were then used to analyse the data from the sample. An interval scale of measurement was employed throughout the analysis.
Ethical considerations
Ethical clearance to conduct this study was obtained from the Research Ethics Committee of the Tshwane University of Technology (Ref. no.: REC/2019/07/010). Furthermore, the researcher obtained institutional approval from the six provincial health departments.
Results
The findings of the study focussed on the correlation between employee engagement and staff morale among nurses in the public sector. The result proved high correlation between staff morale and high staff engagement; however, causal relationship was not measured.
Data collected from the nursing staff in the public sector generated two themes and six sub-themes which will be discussed in the next section.
Socio-demographic description of study participants
A total of 461 nursing staff working in the public sector from six provinces (Western Cape, Eastern Cape, Northern Cape, Free State, North West, and KwaZulu-Natal) participated in the study. Tables 1 to 4 outline the frequencies of the participants. Table 5 outlines the themes and sub-themes as they emerged.
Theme 1: Employee engagement
High levels of employee engagement among nurses were associated with a rise in staff productivity, job satisfaction and altruistic conduct (Kim & Seo 2021:2). Szilvassy and Širok (2022:2) identify few factors of the (nurse) work environment that influence employee engagement: job complexity, role ambiguity, high responsibility, physical and mental exhaustion, the lack of job control, span of control and workload, the lack of opportunities for intellectual and professional growth, inadequate leadership, insufficient social support from colleagues and/or supervisors, difficult nurse-doctor collaboration and effort-reward imbalance.
Alkorashy and Alanazi (2023:2) attest that employee engagement can increase nursing service quality by inspiring nurses to use their full knowledge and expertise. Nurses with high levels of involvement demonstrated enhanced caring behaviour, job satisfaction, and high morale.
The three sub-themes (compensation, career growth and working environment) were found to be the major concern for the nursing staff to be engaged in their workplace.
Sub-theme 1.1: Compensation
The majority of participants felt that they are underpaid as the work that they do is too demanding, and therefore they tend to be less engaged in their work. On the contrary, a minority of the participants were happy with the salary they are receiving.
Sub-theme 1.2: Career growth opportunity
Career growth opportunity was reported as important for nurses by the participants. If they do not grow in their career, they end up losing the opportunity to be promoted and get stuck in one position for a long time which then makes them less engaged.
Sub-theme 1.3: Work environment
Some participants in this study reported the importance of creating safe work environments which promote greater engagement in their work. They also added that safe work environment promotes the quality care of patience.
Theme 2: Staff morale
A study conducted by Mphono (2018:7) reveals that salary raises, according to public nurses, would be a major element in raising their morale. He further states that poor health facility administration was identified as a major factor affecting staff morale. Public-sector nurses do not get the same recognition as private-sector nurses. Compared to individuals in the public sector with lower morale, private-sector nurses are happier with their supervisors, more dedicated to their work and have higher morale (Aeschbacher & Addor 2018:2).
The study by Mutshatshi, Mothiba and Malema (2022:3) highlights the perceived benefits of ongoing in-service training among nurses who implement the nursing process in patient care. These benefits include equipping nurses with the necessary knowledge and skills for the nursing process, improving the quality of patient care and staff motivation, promoting information sharing among nursing personnel, and enhancing overall staff morale.
The study’s findings revealed the three important sub-themes reported on staff morale being rewards and recognition, work environment and job satisfaction.
Sub-theme 2.1: Supervisors
Some participates reported that there is a lack of communication by their supervisors and their supervisors not encouraging their development lead to low morale. Other participants reported to have high morale as their supervisors encourage their development and they are happy with their leadership style.
Sub-theme 2.2: Work environment
The study’s findings showed that work environment contributes to low or high staff morale. The better and safe work environment, the nurses’ level of morale becomes higher. The participants revealed that the good work environment boosts their morale in the workplace.
Sub-theme 2.3: Job satisfaction
Some participants perceived job satisfaction as a predictor of staff morale. The findings show that job satisfaction is mostly determined by satisfaction with the facility’s availability and adequacy of supplies, as well as the frequency of care planning meetings. On the other side, staff perks were related with job satisfaction, which led to strong staff morale.
Correlation analysis
To test the relationship between employee engagement and staff morale, Pearson correlation was used. Pearson correlation measures the linear correlation between two sets of data. The covariance of two variables is divided by the product of their standard deviations, resulting in a normalised measurement of covariance with a range of −1 to 1 (Obilor & Amadi 2018:12).
As depicted in Table 6, staff morale is positively related to employee engagement (r = 0.644, p < 0.00). There was a high, significant correlation between staff morale and employee engagement. This means that there is enough evidence to suggest that there are significant relationships between staff morale and employee engagement among the nursing staff in the public sector. p < 0.001: Indicates a high significant correlation, making it very unlikely that the observed relationship is because of random variation.
| TABLE 6: Correlations between employee engagement and staff morale. |
There is a statistically significant, moderately strong positive relationship between staff morale and employee engagement in the nursing public sector. This suggests that higher staff morale is associated to higher employee engagement and vice versa.
However, correlation does not imply causation – this result does not determine whether one directly causes the other. Further investigation would be needed to explore potential casual relationships.
Regarding the age variable, the results are significant, and yet there are small correlations between age and employee engagement and staff morale. There is a significant yet small positive correlation coefficient of (r = 0.173, p > 0.01) between age and employee engagement. There is also small positive correlation between staff morale (support factor) and age (r = 0.188, p < 0.00), as well as a small positive correlation coefficient between employee engagement and age of (r = 173, p < 0.00). The results reveal no meaningful relationship between the employee engagement and staff morale and length of service (Table 7).
| TABLE 7: Correlations of themes between employee engagement and staff morale. |
Discussion
Previous studies involving South African public health sector nursing staff indicated that there were different factors that influenced workplace morale and engagement (Conradie et al. 2017:3; Khan & Khurshid 2017:219). Therefore, this study explored the relationship between employee engagement and staff morale of the nursing staff in the public health sector in South Africa.
In terms of employee engagement, the data analysis positively revealed that 365 (79.2%) participants agreed and strongly agreed that good compensation is the major factor that influences high levels of engagement, with only 36 (7.7%) who strongly disagreed with that. This is in contrast to the 167 (36.2%) participants who responded in neutral that good compensation is the major factor that influences high employee engagement. A conclusion can be made that good compensation can motivate the nursing staff to be engaged in their workplace. According to Elnagar (2019:73), employee engagement represents a motivational process driven by compensation and rewards.
The finding regarding career growth opportunities shows negative responses from the participants. There were 297 (64.4%) participants who responded that there is no career growth opportunities in the public nursing sector as they hardly attend training and there is a lack of promotions. Based on these results, it can be concluded that most nursing staff in the public sector are not satisfied with career growth opportunities in their workplace. On the contrary, 78.0% of the participates responded positively that their work environment provides good quality care for the patient that increase their work engagement.
Both job and personal resources may engage employees, who work hard, are involved and feel happily engrossed in their work. Szilvassy & Širok (2022:2) report that nurses with higher engagement experienced less stress facing high job demands. Statistics in terms of staff morale show that 129 (28%) respondents disagreed that there is appropriate rewards and recognition strategy in the nursing public sector, 14 (3%) were neutral, and 318 (69%) agreed and strongly agreed that there is appropriate strategy in that regard. In the context of work environment, 254 (55%) respondents disagreed and strongly disagreed with the item, followed by 152 (33%) who agreed and strongly agreed and 55 (12%) being neutral; they are of the opinion that their work environment is not safe and they do not have the appropriate facilities for staff. There was a positive response from 260 (56.5%) respondents who agreed that job satisfaction lead to high staff morale, while 201 (43.3%) disagreed. It can be concluded that the public sector nursing staff are satisfied with how the Department of Health is taking care of the patients but not with how they take care of them.
Research performed by Ghandour, Elzohairy and Elsayed (2019:180) demonstrates that organisational strength that is in line with intrinsic factors is the desire to help others and the interest in their work. At the same time, concerns were focussed on the influence extrinsic factors, that is pay, workload, and management approach, have on staff morale. Sabitova, Hickling and Priebe (2020:2) further suggested that patients are more likely to receive high-quality care from nurses whose morale is high, and raising job satisfaction could boost productivity and address poor job performance in places with limited or insufficient resources. Pearson’s correlation tool was used to explore the relationship that exists between employee engagement and staff morale. The results are presented in Table 6 and Table 7.
The following results were found between staff morale and employee engagement (r = 0.644, p < 0.00). There was a high, significant correlation between staff morale and employee engagement. This means that there is enough evidence to suggest that there are significant relationships between staff morale and employee engagement among the nursing staff in the public sector.
Limitations of the study
While the findings of the study support the basic evidence of research, the following limitations were identified. The sample size was small. However, it did fall within the prescribed guidelines. A bigger sample size could have yielded more accurate and representative results. The locations are geographically separated, and mailing questionnaires via electronic means produced no acceptable response rate at the outset of data collection. This hindered the data collection procedure and may have had a detrimental impact on the response rate. Of the nine provinces selected for data collection for the study, three chose not to participate for reasons unknown to the researcher. This could imply that the data collected and made accessible to the researcher does not accurately reflect all nine provinces as only six provinces agreed to participate in the study.
Recommendations
In relation to the research findings, the researcher proposes various recommendations which are aimed at exploring the relationship between employee engagement and staff morale in the public nursing sector of South Africa. If these recommendations are adopted and implemented, they would assist human resource management and line managers in boosting high staff morale and having highly engaged staff. Staff must also develop strategies to support one another to promote a holistic work environment. Line managers should have regular meetings to discuss issues affecting the work environment. Managers should develop systems for effective two-way communication, clarifying role and performance expectations.
Conclusion
This study explored the literature relating to two constructs: employee engagement and staff morale. It provides some historical perspectives and theoretical foundations for the constructs in the nursing sector. The intention behind this presentation of the constructs in this study is to better understand the variables and their relationship to one another. This led to the researcher of this study to conclude that, there is a relationship between employee engagement and staff morale. If the public nursing sector staff morale is high the employees tend to be engaged in their work.
Acknowledgements
The authors would like to thank the Department of Health for permission to conduct the study and the nursing staff who participated in the study. This article is partially based on the author’s thesis entitled ‘Employee well-being, staff morale, occupational stress and engagement in the public nursing sector of South Africa’, towards the degree of Doctor of Technology Human Resources Management in the Department of Management Sciences, Tshwane University of Technology, South Africa on October 2023 with the supervion of Prof I. Swarts and Dr M. M. Mmako.
Competing interests
The authors declare that they have no financial or personal ties that could have inadvertently impacted their decision to write this article.
Authors’ contributions
L.M. chose the study area and conceptualised the design, contributed to the collection, analysis and interpretation of the data, and drafted the manuscript. I.S. and M.M.M. revised and edited the intellectual content and supervised the study.
Funding information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
The authors confirm that the data supporting the findings of this study are available within the article and its references.
Disclaimer
The views and opinions expressed in this article are those of the authors and are the product of professional research. The article does not necessarily reflect the official policy or position of any affiliated institution, funder, agency or that of the publisher. The authors are responsible for this article’s results, findings and content.
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