LITERATURE REVIEW: Factors motivating registered nurses’ movement from clinical to education roles

Andrew Toneycliffe Kate Norris Isabel Jamieson About the authors: Andrew Toneycliffe, RN, PGDip HlthSci (mental health), NZCertATT, is a nursing lecturer and academic staff member at Te Hoe Ora ki Manawa, Department of Health Practice, Ara Institute of Canterbury, Christchurch. His correspondence address is: [email protected] Kate Norris, RN, PhD, is a senior nursing lecturer at Ara Institute of Canterbury. Isabel Jamieson, RN, PhD, is a senior lecturer in the Faculty of Health, University of Canterbury, Christchurch. This article was accepted for publication in May 2024.	ABSTRACT Aim: This literature review identified existing literature exploring the motivation for registered nurses (RNs) in clinical practice to move into nursing education. Background: To become an RN, a person must complete a pre-registration degree. Throughout this process, nurse educators educate, assess, tutor, and guide nursing students to complete their degrees. With an increased demand for RNs, the retention of a nursing education workforce is critical. Methods: Five electronic databases were searched – CINAHL, ProQuest, Science Direct, PubMed and nzresearch.org.nz. Results: After applying the inclusion criteria, seven research articles were selected for review. Findings: RNs who moved from clinical practice to nursing education identified several benefits and barriers to their decision. The increased autonomy and opportunity to give back to nursing and invest in future nurses appealed to some. Academic achievement motivated others, while dissatisfaction with the clinical practice environment pushed others towards the change in role. Conclusion: There is pressure on schools of nursing to accept more students to alleviate workforce shortages. This means more nursing educators are needed, to teach larger and more frequent intakes. Understanding what motivates an RN to move from clinical practice to education will help improve recruitment and retention of nurse educators. More research is needed to investigate these motivations, especially in the New Zealand context.
KEYWORDS motivation, satisfaction, dissatisfaction, Herzberg, nursing education, clinical

INTRODUCTION

ACCORDING TO THE Nursing Council of New Zealand (2020), to become an academic staff member and teach nursing in a tertiary institution, a registered nurse (RN) must hold a relevant master’s degree or be on a path to completing a master’s degree within four years of appointment to an academic teaching role. Completing a certificate in adult teaching and learning may also be required. This literature review aims to discuss what factors motivate an RN working in clinical practice to move to an education role. Herzberg’s (1959) motivational hygiene theory has been used to provide a framework to analyse push or pull factors that encourage RNs to move from clinical practice into education.

BACKGROUND

To become an RN in New Zealand, a person must complete an approved three-year bachelor’s degree or two-year pre-registration master’s degree (Nursing Council of NZ, 2022a). As at the end of 2023, there were 75,173 RNs and nurse practitioners holding current annual practising certificates in New Zealand (Nursing Council of NZ, 2023). RNs must practise according to the competencies outlined by the Nursing Council and hold a valid practising certificate that is renewed annually (NCNZ, 2022b). RNs are employed primarily in clinical practice, where most graduates find employment through supported-entry new-graduate programmes. These programmes are nurse entry to practice (NETP) or nurse entry to specialist practice (NESP) (Te Whatu Ora Health New Zealand, 2023a). They are designed to support new graduates in their first year of nursing practice.

Herzberg’s motivation-hygiene theory

In the 1950s, American clinical psychologist Fredrick Herzberg explored the attitudes of 200 engineers and accountants towards their work. His aim was to find out what prompted their work attitudes and the impact these attitudes had on their work. His seminal work on motivational theory was developed and refined and eventually referred to as the motivation-hygiene theory (Herzberg et al.,1959). Recent research using Herzberg’s motivation-hygiene theory has included studies of the predictors of nursing job satisfaction and retention, the influence of job satisfaction and the intent to stay in academia, the views of Generation Y New Zealand RNs on nursing and their career, and an exploration of how mentoring and satisfaction affect retention during a faculty shortage (Derby-Davis, 2014; Haverdink, 2018; Jamieson et al., 2015; Richards & Kieffer, 2023). Herzberg’s theory has been used as the framework for this literature review of factors influencing nurses to move from clinical to education roles.

‘Push’ and ‘pull’ factors

Herzberg’s motivation-hygiene theory consists of two factors: motivators and hygiene factors. Motivators have a “pull” influence, drawing a person towards employment and personal growth, advancement, responsibility, the work itself, achievement, and recognition (Simon, 2022). Motivators increase satisfaction, often reflected in the person’s attitude towards their work (Herzberg et al., 1959). Unlike motivators, hygiene factors only prevent dissatisfaction. Hygiene factors include
employment security, personal life, relationships with peers, employment conditions, company policy and administration, supervision, relationship with their supervisor and salary. Hygiene factors are peripheral elements influencing a person’s choice to pursue employment (Herzberg, 1968; Herzberg et al., 1959; Smith & Shields, 2013). A key consideration when reviewing hygiene factors is they are also considered “push” factors. Hygiene factors often influence a person to leave a job, hence the concept of being “pushed” from one employment situation into another (Herzberg, 1968). Employees tend to expect that satisfactory hygiene factors pre- exist in employment at the time they are hired. Hygiene factors will not result in employment satisfaction, but adequate hygiene factors can prevent employment
dissatisfaction. Hygiene factors do, however, form a foundation from which motivators can increase satisfaction.

Understanding the factors that may “push” or “pull” a person to or from employment is vital when gaining insight into their motivation to change jobs. Consider two people applying for the same job, one of whom is “pulled” towards the role but the other “pushed” away from previous employment due to dissatisfaction. The person moving away from inadequate hygiene factors (ie “pushed”) is not necessarily motivated to be elsewhere but is dissatisfied with their existing employment. By comparison, when a motivator “pulls” someone towards a different job, the person will generally experience increased satisfaction in the new position.

METHODS

A systematic database search was conducted to gather published information on factors influencing RNs to move from clinical to education roles. The search occurred between January and March 2023 with the following inclusion criteria:

Inclusion criteria

1. Primary research with full text available, written in English, and published between 2013 and 2023.
2.  Related to the motivation for RNs to move from clinical to nursing education.
3. Includes a theme identifying motivation, even if the focus of the research was not.

Information sources

Five electronic databases were searched for this review: CINAHL, ProQuest, Science Direct, PubMed, and nzresearch.org.nz. There was a noticeable dearth of literature relating to this topic. Seven published articles were selected for this literature review – two from Science Direct, two from nzresearch.org.nz, one from CINAHL, one from ProQuest, and one from PubMed (see Table 1).

Table 1: Databases searched for relevant literature

Database	Relevant studies found	Date range inclusion
Science Direct	2	2013-2023
nzresearch.org.nz	2	2013-2023
CINAHL	1	2013-2023
ProQuest	1	2013-2023
PubMed	1	2013-2023
Total number of relevant studies	7	2013-2023

The seven studies were analysed to identify common themes. Once the themes were identified, they were compared to Herzberg’s (1968) motivation-hygiene theory to determine whether the theme focused on motivation or satisfaction.

FINDINGS

The findings of this review identified what pulled or pushed an RN to move from clinical practice to education (Alkarani & AbdElbagy, 2021; Arian et al., 2018; Blaine, 2015; Brown & Sorrell, 2017; Laari et al., 2021; Logan et al., 2016; Murray et al., 2014).

Four themes were identified:

1. Benefits and barriers
2. Autonomy and altruism
3. Academic satisfaction
4. Clinical dissatisfaction

1) Benefits and barriers

Research exploring the transition experience for new academic staff moving from clinical practice, rather than motivation to move, was common (Blaine, 2015; Brown & Sorrell, 2017; Logan et al., 2016; Murray et al., 2014). Murray et al (2014) found that a motivator for new academic staff was wanting to obtain higher qualifications while being in an environment that valued research. This study also found that participants struggled with the initial transition period in academia, having moved away from the clinical role where they had gained experience and established themselves. New academic staff who had poor support, were denied tenured positions and received an inadequate salary experienced more “push” factors than “pull” factors during their transition into academia, resulting in low levels of
motivation and high levels of dissatisfaction. Blaine (2015) explored the transition process from clinical practice to academia; this study focused more on the benefits and the barriers to the transition in a United States context. Workload and salary were identified as hygiene factors affecting employee satisfaction. Motivational factors included personal fulfilment, enjoying teaching, or having previous
experience in an education role. These themes align with Herzberg’s motivators of personal growth, the work itself and recognition. While this study mentioned motivators, they were not examined in depth as the focus of the research was on the transition experience. However Blaine (2015) did say there was a need to explore the motivation of nurses transitioning from clinical practice to academia more thoroughly, and that doing so could help alleviate the nursing academic shortage and improve retention.

2) Autonomy and altruism

Logan et al (2016) compared the experience of the RN moving from clinical practice to academia in the United Kingdom to that in Australia. Previous teaching experience and the desire to pass on knowledge and skills to the next generation of nurses were common motivators in both the United Kingdom and Australian nurses. Logan et al discuss how personal growth is a factor in “pulling” nurses in clinical practice into academia. For participants in their study, personal growth included engaging in successful research and obtaining higher qualifications, which contributed to their satisfaction with their academic role.

Altruism was a theme identified in Brown and Sorrell’s (2017) study by participants who wanted to “give back” to nursing. These researchers focused on exploring the challenges novice nurse educators experienced while they moved from clinical practice to nursing education. The idea of “giving back” was a recurring theme referred to by participants, who wanted to share knowledge and guide the next generation of nurses (Brown and Sorrell, 2017; Logan et al., 2016; Murray et al., 2014).

3) Academic satisfaction

Factors affecting employee satisfaction were the focus of a systematic review by Arian et al (2018). For RNs in the reviewed research, these included personal, managerial, economic, organisational, professional and academic factors. Academic factors included opportunities for promotion, to research and publish, and to gain higher educational qualifications. These factors align with Herzberg’s (1968) motivators of achievement, recognition, advancement and personal growth. Arian et al included Herzberg’s motivation-hygiene theory in their research, which made sense, as the focus of their research was on the satisfaction of nurse educators. Logan et al (2016) discussed how personal growth is a “pull” factor, attracting nurses in clinical practice to education. Personal growth included engagement in successful research and obtaining higher qualifications, which are considered motivators by Herzberg et al (1959).

4) Clinical dissatisfaction

Exploring the motivations for nurses in clinical practice to shift to nursing education, Laari et al (2021) identified four themes: dissatisfaction with clinical nursing, the quest for a flexible work role, a quest for autonomy, and previous teaching experience. These themes also align with Herzberg’s (1968) motivation-hygiene theory. Being dissatisfied with clinical nursing included being denied the opportunity for further education, disagreements with leadership and long work hours. These clinical dissatisfaction subthemes had a “push” effect for some participants, who moved out of their clinical area without having a “pull” factor attracting them towards education. Wanting a flexible employment role and seeking autonomy align with Herzberg’s motivators “the work itself” and “responsibility” (Herzberg, 1968). Frequent excessive supervision and experiences of being belittled by medical staff/senior nursing staff “pushed” nurses to seek roles with more autonomy. Participants with teaching and preceptorship experience were motivated to move into academia as part of their career pathway (Larri et al., 2021). Previous teaching experience can be closely aligned with the autonomy motivator.

Alkarani and AbdElbagy (2021) explored factors motivating clinical nurses to move to academia. Of the nine participants in their study, eight had postgraduate qualifications (master of nursing degree or a doctor of philosophy), and one had an undergraduate bachelor’s degree. The satisfaction factors they identified that aligned with motivation-hygiene theory motivators included the vitality of university work, opportunities for postgraduate studies, gaining experience, and the desire for change – these aligned to Herzberg motivators “the work itself”, “achievement” and “personal growth”.

Literature published before 2021 (Arian et al., 2018; Blaine, 2015; Brown & Sorrell, 2017; Logan et al., 2016; Murray et al., 2014) focused on the transition experience from clinical practice to academia rather than on the motivations for the transition, although there was some information relating to participants’ motivation. Literature after 2021 focused more on motivation for shifting from clinical practice to academia or broad motivations for choosing teaching as a second career (Alkarani & AbdElbagy, 2021; Laari et al., 2021). These studies mention several motivators (Alkarani & AbdElbagy, 2021; Laari et al., 2021) that “pull” nurses from clinical practice to academia, including lifestyle, gaining higher qualifications, potential for advancement within academia, enjoying previous teaching experience or altruistic reasons such as giving back to nursing by passing knowledge on to the next generation.

IMPLICATIONS FOR THE PROFESSION

With increasing pressure on schools of nursing to educate more nursing students, there is increased demand for nursing lecturers. Te Whatu Ora – Health New Zealand (2023) has judged that nursing schools will need an additional 8000 full-time equivalent nurses by 2032. A shortage of nursing lecturers would undermine nursing schools’ capacity to educate nursing students while the need for nurses continues to grow (Longmore, 2023). Nurse educators in the tertiary sector make up 1.5 per cent of the total nursing workforce in New Zealand and have been identified as an at-risk workforce (Longmore, 2023). Longmore states this is largely due to many lecturers nearing retirement and the disparity in salary with nurses in clinical practice being a barrier to recruitment and retention. In 2022, entry-level salaries for nursing educators started at around $80,000 per year or less in some tertiary providers, much less than under the Te Whatu Ora collective agreement, where an equivalent senior nurse can start at $96,000 per year (Longmore, 2023; Te Whatu
Ora – Health New Zealand, 2022). The rising cost of living further exacerbates the pressure on academic salaries, increasing to 7.2 per cent in the 12 months from July 2022 to July 2023 (Statistics New Zealand, 2023).

A shortage of nursing educators in the tertiary sector also brings the risk that research and innovation opportunities will be missed. Currently, 3 per cent of nurse educators in the tertiary workforce identify as Māori or Pacifica (Longmore, 2023). Longmore suggests that increasing the number of Māori and Pacifica educators would have a flow-on effect of attracting more Māori students to apply for nursing. They could also be involved in promoting research, and influencing policy and procedural change. The Health Workforce Plan for 2023/2024 (Te Whatu Ora – Health New Zealand, 2023) identified the need for more Māori and Pacific nursing students.

Considering the dearth in literature on what motivates nurses moving from clinical practice to education, primary research on this topic in the New Zealand context is needed. Insight on these motivations could be used to improve recruitment and retentions of nursing lecturers.

CONCLUSION

Understanding what motivates an RN to move from clinical practice to nursing education has not yet been explored in New Zealand. The limited international literature cannot always be usefully transferred to the New Zealand context. Herzberg’s et al (1957) motivation-hygiene theory provides a framework to identify the push and pull factors affecting individuals and the satisfaction or motivation they provide.

To fill the shortage in the nursing workforce, schools of nursing are accepting more applications than they have ever done. To ensure new graduates are prepared to be safe and competent in their clinical practice, an adequate number of nurse educators is needed. To retain nurse educators, it is important to understand their motivations. Future research should include a qualitative descriptive study exploring what motivated new nursing educators to move from clinical practice.

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