Abstract
In order to stay up-to-date in the nursing field, nurses must pursue continuous education. This study examined nurses’ motivations to take part in continuing education activities by conducting a survey amongst a sample of nurses employed in two hospitals in south-east Morocco. The survey was carried out using a two-part self-administered questionnaire. Out of 144 nurses who received the questionnaire, 118 (84%) replied. The results showed that the majority of nurses have never participated in a continuing education session in the last 3 years. Respondents’ motivation for continuing education was mainly intrinsic, with the emphasis on factors related to professional competence and knowledge seeking. The use of such results can therefore be of great use to both managers and practitioners in planning continuing education programmes. However, it is desirable that more studies take place to investigate further the issue of continuing education with the aim of promoting and developing professional nursing skills.
Introduction
The population increasing demands for health care, and the challenges associated with technological advancement and digitalisation in the healthcare area require that health-care workers make ongoing investments in improving their professional skills (Hababa et al., 2020; Shahidi et al., 2010).
Continuing education is one of the guiding principles in fields related to health sciences, including nursing. It is also referred to as ‘continuing professional development’, ‘lifelong learning’ or ‘knowledge transfer’ (Furze & Pearcey, 1999; Hegney et al., 2010; Kourkouta et al., 2021). It is a continuous process in which nurses actively engage throughout their professional careers, to acquire new information and to develop their personal and professional skills (Flores Peña & Alonso Castillo, 2006; Ouellet & Mukamurera, 2017).
To fulfil the primary goal of enhancing the quality of health-care, international organisations recommend strengthening the key actor, human capital, by elaborating strategies for the development of human resources for the healthcare domain. In fact, basic training alone is not enough, especially in the field of nursing, where health-care workers are always confronted with different and basically unpredictable care situations in highly complex patient-care environments. Thus, there is an unequivocal global agreement regarding the importance of continuing education for health workers. By bridging initial training gaps and facilitating the adaptation of professionals to current scientific advancements, continuing education will protect the public and continuously improve the quality of care and services (Hababa et al., 2020).
Certainly, the key element for the success of a training session is the participation of the staff. Therefore, knowing the factors that encourage the motivation of nurses to participate in training is an important point to consider. In a review conducted by King et al. (2021), the self-motivation of nurses was recognised as being crucial in enabling continuing professional development impact for development and improvement in the workplace (King et al., 2021). As such, a better understanding of motivational factors throughout nurses’ careers could lead to motivating and effective educational strategies to ensure quality healthcare delivery.
The issue of participation in continuing education has been of interest to several researchers. In this context, the results of empirical studies showed that the main factors motivating nurses to enrol in continuing education were characterised by an intrinsic or extrinsic orientation (Ebrahimi et al., 2012; King et al., 2021; Kourkouta et al., 2021; Mohammad Hossini et al., 2012; Ni et al., 2014; Tachtsoglou et al., 2020; Wang et al., 2018).
To explain the influence of factors on training motivation, researchers base their argument on the fact that learners are motivated by the intrinsic and extrinsic rewards they will receive as a result of their training. Thus, motivation is derived from the anticipation of rewards (Facteau et al., 1995; Herzberg, 1971). Following research conducted in a set of companies Leplat (2002) highlighted four types of orientation that reflect adults’ reasons for taking training: intrinsic, extrinsic, learning, and participation orientations.
First of all, intrinsic orientation reflects the motives for engaging in training, which find their response in the very fact of being in training. Here, the expected result is confused with the training activity itself. Then, the extrinsic orientation, which concerns motives whose satisfaction lies outside the training. Next, the learning orientation translates motives of commitment to training aimed at acquiring training content (knowledge, skills and attitudes). Finally, the participation orientation reflects motives that are satisfied by enrolment and/or presence in training, the reason for enrolment being independent of the learning of knowledge (Leplat, 2002).
Intrinsic factors are linked to the content of the task. In fact, the absence of this type of factor leaves workers in a state of indifference, whereas their existence brings job satisfaction. These are the need for achievement, the need for identification, the work itself, responsibility, the need for advancement and personal development. Extrinsic factors, on the other hand, are associated with dissatisfaction. They refer to the work context and include organisational policies, supervision, relations with management and working conditions (Herzberg, 1971).
On the basis of empirical research, the issue of participation in continuing education has been of interest to several researchers. In this context, several studies have shown that the main factors motivating nurses to enrol in continuing education were their desire to improve their professional skills and knowledge, to keep up-to-date with their professional practices and to improve their ability to serve patients (Ebrahimi et al., 2012; Nalle et al., 2010; Nsemo et al., 2013; Waddell, 1993).
For Ni et al. (2014), more than 60.3% of nurses believed that the five main reasons why they participated in continuing education were to update their knowledge, increase their clinical practice skills, enhance their comprehension, acquire the knowledge required to advance professionally and increase their level of scholarship (Ni et al., 2014). Furthermore, 80% of nurses felt that the information taught in continuing education courses was not relevant to the wards in which they worked, and 60% were against such teaching (Ebrahimi et al., 2012).
In the Moroccan context, where continuing education is not mandatory, the results of a study conducted to assess the efficacy of continuing education for healthcare professionals and to identify the factors influencing the transmission of information reveal a complete lack of knowledge transfer. In terms of factors hindering transfer, beneficiaries identified three types of factors: personal, organisational and situational. Furthermore, 34.8% of nurses were not motivated to put their training to use (Hababa et al., 2020). In their study, the focus was on the aftereffects of continuing training activities. However, the preconditions for engaging in such activities may be quite significant. Because training is affected by what occurs before, during and after training, failing to consider some variables prior to training might result in training failure (Wexley & Latham, 2002). A study in the surgical emergency unit of the Ibn-Rochd Hospital in Casablanca revealed that the motivation of nurses and doctors is influenced by extrinsic factors; moreover, other factors such as the adequacy between the training topics and the needs in the field, as well as the experience during previous training, can also influence their motivation (Gouifrane et al., 2018).
In this context, the present research aims to examine nurses’ motivation to take part in the continuing education programmes at the provincial hospital of Ouarzazate in south-east Morocco.
Material and Methods
Study Design, Participants and Sampling Method
A quantitative cross-sectional survey was designed to investigate the motivation of nursing staff to participate in continuing education programmes at the provincial hospital of Ouarzazate in south-east Morocco. The study was conducted between February and June 2022. The provincial hospital is composed of two institutions incorporating several types of units, including visceral surgery, internal medicine, psychiatry, paediatrics, emergency, and intensive care, cardiology, ophthalmology and obstetrics-gynaecology.
In the present study, we used a census sampling method to select 144 nurses working at the hospital who have agreed to participate.
Data Collection
Data collection was carried out by means of a self-administered questionnaire that was developed by various reviews of literature (Gouifrane et al., 2018; Kamariannaki et al., 2017; Shahhosseini & Hamzehgardeshi, 2015). The instrument was a two-part questionnaire consisting of demographic information and motivational factors facilitating nurses’ participation in continuing education. Participants were asked through this questionnaire to indicate the importance given to each motivational factor by a value between 0 and 100, so each factor will have a value and each category of factors (intrinsic and extrinsic) will have an average (Gouifrane et al., 2018).
The content validity of the tool was assessed by giving it to three experts from the field of nursing. It was pretested on 30 nurses working in non-hospital institutions to ensure the clarity of the questions and to detect ambiguous ones. The Cronbach’s alpha coefficient of the instrument was 0.77.
Data Analysis
The data collected was analysed using the software ‘SPSS.25.0’. A p-value of 5% was retained. Quantitative variables were expressed as mean ± standard deviation. And qualitative variables are expressed as frequencies and percentages. The Chi-square test was used for the correlation between variables.
Ethical Considerations
Permission was obtained from the hospital administration to conduct the study. The ethical rules are respected and announced to the respondents before collecting the data, namely, (a) explaining to the nurses who participated in this study the purpose of the survey, (b) respecting the anonymity of the participants, (c) obtaining the consent of the persons participating in the study and (d) ensuring confidentiality of the information.
Results
Sample characteristics.
In this study, 63.6% of the participants were female, and 36.4% were male. The participating population is relatively young, with 45% of the participants aged between 21 and 30 years old. The majority of the population surveyed is married, with a percentage of 63.6%. With regard to seniority, 51.7% of participants had been working for 0–5 years, while only 14.4% had been working for more than 15 years.
The Participation of Nurses in Continuing Education Activities
According to our results, 57% of nurses have never attended a continuing education session during the last 3 years. Moreover, 51% of female participants in our study have already participated in continuing education sessions during the last 3 years, while only 30% of male nurses have participated. The relationship between gender and participation in continuing education, according to the Chi-square test, is statistically significant (p Value = 0.031 < 0.05). Furthermore, 47.1% of nurses who have already participated in continuing education activities are between the ages of 21 and 30, and 31.4% falling between the ages of 31 and 40. The age-participation relationship in continuing education is not statistically significant (p value = 0.950 > 0.05). In terms of the topics presented to nurses, 60.2% believe that the topics presented in the context of continuing education over the last 3 years do not apply to their work departments.
Perceived Level of Motivation to Participate in CE Sessions
According to the responses of the participants, the majority of them (52%) stated that they had a high level of motivation to participate in the continuing education sessions, 40% had an average level and only 3% had a low level of motivation (Figure 1). Nurses perceived level of motivation to participate in CE sessions.
The results show that women are more motivated to participate in continuing education sessions than men, with 59% of women having a high level of motivation compared to 41% of men (Figure 2). 49% of the respondents who declared a high level of motivation were in the 21–30 age group. However, the relationship between motivation and age (X2 = 16.6, p value = 0.55), and between motivation and gender (X2 = 2.90, p value = 0.407) is statistically insignificant (p value > 0.05). Perceived level of motivation to attend a CE session according to participant’s gender.
Intrinsic and Extrinsic Factors Facilitating Participation in CE Actions
Intrinsic factors influencing participants' motivation to participate in CE sessions.
aParticipants have to indicate a score between 0 and 100 for each item.
Extrinsic factors influencing participants’ motivation to participate in CE sessions.
aParticipants have to indicate a score between 0 and 100 for each item.
The distribution of extrinsic motivators according to respondents’ gender.
Discussion
The study aimed at 144 nurses, with 118 (82%) responding to our questionnaire. The general characteristics of the respondents are as follows: (a) a predominance of the female gender (63.6%), (b) the age range between 21 and 30 years is the dominant one (44.9%), (c) 63.6% are married and (d) 51.7% have less than 5 years of seniority.
Nurses’ Participation in CE Sessions
According to our results, the majority of nurses (57%) have never participated in continuing education activities during the past 3 years, a finding that is at odds with Al-Majid study conducted in (2012) which showed that most nurses (84%) have participated in continuing education activities during the last 12 months (Al-Majid et al., 2012). In the Chinese context, where continuing education is mandatory, a participation rate of 94% was recorded. However, whether continuing education is mandatory or optional, nurses have to be motivated to engage in such activities (Furze & Pearcey, 1999).
The results of the present study also show that 74.5% of the participants in the continuing education sessions are female. The relationship between gender and continuing education participation during the last 3 years is significant (p value = 0.031 > 0.05). This finding is in line with the study conducted by Marceau et al. (2013) which showed that 67% of participants in a continuing education activity for trauma nurses were female.
For the application of continuing education topics, 60.2% of the participants in the present study mention that there is a mismatch between the continuing education topics and their real needs at their working sites. This is in line with the research of Gouifrane et al. (2018) showing that more than 65% of the participants claim that the proposed training topics were not adequate for their needs in the field (Gouifrane et al., 2018).
Level of Motivation to Participate in CE
In terms of nurses' motivation to attend CE activities, 52% of the nurses reported having a high level of motivation. Furthermore, this (high) level of motivation was recorded among the age group between 21 and 30 years (25.4%). This rate is higher than that found in the study by Gouifrane et al. (2018), which shows that only 14% of the very young population experiences a high level of motivation (Gouifrane et al., 2018).
Motivational Factors for Participating in CE Session
The results of this study show that both internal and external factors play an important role in motivating nurses to take part in continuing education activities, with a predominance of the average of intrinsic motivating factors (M = 79.27) compared to the average of extrinsic motivating factors (M = 40.46). This indicates that nursing professionals’ interest in participating was primarily influenced by a desire for professional development and improvement and less dependent on external factors. The highest average motivating factors for participating in continuing education were those related to ‘updating knowledge’, ‘providing quality patient care’, improving clinical skills and ‘job satisfaction’. These results corroborate those of similar studies which have shown that the main factors motivating nurses to participate in continuing education are the desire to acquire and update their nursing knowledge, to improve their practical skills and their overall qualities (Al-Majid et al., 2012; Kamariannaki et al., 2017; Ni et al., 2014; Shahhosseini & Hamzehgardeshi, 2015). Nevertheless, this result is in contrast with that reported by Gouifrane et al. (2018) who confirmed the dominance of extrinsic motivational factors (with a mean of 77) over intrinsic factors (with a mean of 66) (Gouifrane et al., 2018). In addition, their study results showed that remuneration or career advancement and recognition by the hierarchy are the most motivating factors for nurses to participate in continuing education sessions (Gouifrane et al., 2018).
In terms of gender, the present study shows that for women, the intrinsic (79.85) and extrinsic (M: 43.40) motivational factors means are higher than for men (intrinsic M = 78.3% and extrinsic M = 35.35%). This result is consistent with research performed by Gouifrane et al. (2018), which revealed that women have a higher level of intrinsic (M = 69%) and extrinsic (M = 80%) motivation than men. Our above-mentioned findings, which show a higher participation rate of women in CE sessions over the past 3 years, confirm this higher level of motivation.
This is one of the few studies on continuing education carried out among Moroccan nurses; however, some limitations of this study should be considered. Motivation is a latent variable that is relatively difficult to assess with a questionnaire. In addition, the study was limited to hospital nurses, whereas the participation of nurses working in other health institutions would have given a more comprehensive picture of the reasons for participation of nurses in continuing education programmes. Therefore, generalisation outside of this hospital should be made cautiously.
Overall, the results of this study highlighted the nature of nurses’ motivation to participate in continuing education activities. The perceived level of motivation of our studied population is high, and its nature is intrinsically oriented. If the CE activity does not satisfy the nurses’ internal motivations and actual needs, motivation will be reduced. The use of such results can therefore be of great use to both managers and practitioners in planning continuing education programmes that focus, among other things, on the motivation of nurses, especially in the contemporary Moroccan context where the health sector is undergoing a new reform. Otherwise, the low rate of participation and the inadequacy of topics offered imply further investigation. The effectiveness, quality and content of the present continuing education offerings supported by hospital managers must be assessed, as well as the nurses’ attitudes toward continuing education.
Conclusion
Continuing education is a process that prepares nurses to be more effective and efficient in their current and future jobs, as well as to change their ways of thinking and acting. Indeed, the population’s increased demand for care can only be met through the continuous training of nursing staff. The first key to the success of such training is the participation of nurses in training sessions.
In this regard, this study enabled us to address the issue of nurses’ motivation to attend continuing education sessions. The study emphasised the intrinsic factors that particularly motivate nurses to participate in continuing education activities. In fact, implementing educational programmes based on motivational factors is regarded as critical. This study adds value to the field of health care. However, more research is needed to investigate the issue of continuing education with the goal of promoting and developing professional nursing skills.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
