Introduction to the issue Employee motivation in any sector is determined by the dynamics between individuals in the organization and their work environment, as well as how this interplay corresponds with the wider societal framework (Bhatnagar, 2014). In any organization, the most valuable capital is primarily the employees. Nurses play an irreplaceable role in the provision of nursing care within healthcare systems. Organizations that prioritize the development of knowledge and skills of their employees, support their work motivation and create opportunities for their professional development are generally more successful and efficient (Doloh, Tamtomo, Sulaemas, 2018). Nurses are a key source of health care provision, as within the exercise of their profession they enter into several roles through which they can satisfy the needs of patients and thereby contribute to increasing the level of quality of services provided by health organizations. According to the WHO, approximately 27 million people work in nursing and midwifery worldwide. Nurses make up 60 to 70% of the total workforce in hospitals (Sar, Bachliar, 2018, WHO, 2020). The shortage of nurses is a worldwide phenomenon, not excluding the Slovak Republic. According to the Slovak Chamber of Nurses and Midwives (SK SaPA), more than 15,000 nurses are missing in Slovakia. A critical area is the turnover of nurses and the aging of the population, which is reflected in the relatively high average age level of these health workers. The average age of nurses in the Slovak healthcare sector is over 50 years, which predicts a trend of massive retirement of nurses in the coming years. This critical shortage may represent a collapse in health care delivery. According to SK SaPA statistics, 2013 nurses and midwives left the profession in 2024 and 267 in January 2025. During the comparable period, 414 graduates entered practice and a total of 1,075 new nurses were registered. These statistics point to the fact that more nurses are leaving the health system than entering the system, which in the long term leads to a deterioration in the availability of health care for patients. The healthcare system cannot achieve the desired results without motivated employees. As already mentioned, nurses play a key role in healthcare by providing high-quality nursing care, solving difficult nursing situations, and representing communication elements between the patient and other medical personnel. Quality nursing care represents the satisfaction of the patient's needs, emphasizing the safety, comfort and dignity of the patient. Such care is characterized by consistency, positive patient outcomes, and high patient satisfaction (Saleh, Eshah, Rayan, 2022, Diana, et al., 2021). In the article in question, we pay attention to the performance motivation of nurses, as it is the performance motivation that contributes to the improvement of the process of providing health care, but above all to the professional satisfaction of patients' needs with a focus on their safety.
Research methodology and research sample
The research was carried out in the form of descriptive cross-sectional research, the aim of which was to obtain current data on the observed phenomenon in the population of nurses working in healthcare facilities in Slovakia. Data collection took place in the period from December 2024 to February 2025. The research sample consisted of 100 nurses working in various types of health care facilities in the territory of the Slovak Republic, while the substantial majority of 98% were women, the average age was 40.9 years, and the average length of practice was 17.6 years. More than half of the respondents worked in shift work, mainly in state medical facilities, while a significant part had completed higher education I. or II. degree.
Sociodemographic and occupational characteristics of the respondents were obtained through a separate part of the research instrument. The criteria for inclusion in the research included: age 18 years and older, practicing the profession of a nurse in a health care facility, active employment with a health care facility, voluntary participation in the research, and giving informed consent. Exclusion criteria included: age less than 18 years, performance of a health profession other than a nurse, absence of a concluded employment relationship with a health facility. The research was carried out in accordance with the ethical principles of the Declaration of Helsinki. Before starting the research, the participants were familiarized with the aim, course and significance of the study. Participation in the research was voluntary, without the right to financial or material reward. The respondents were guaranteed the anonymity and confidentiality of the obtained data, which were used exclusively for research purposes.
Data collection was carried out through a questionnaire method, while a standardized measurement tool DMV - Performance Motivation Questionnaire (Pardel, Maršálová, Hrabovská 1992) was used, which characterizes the motive of performance in terms of four aspects: the aspect of performance behavior, the aspect of aspirational level, the aspect of perseverance in work and the aspect of time orientation to the future. Respondents answered on a five-point scale: 1 - does not apply to me at all, 2 - hardly applies to me, 3 - sometimes applies to me, 4 - often applies to me, 5 - completely applies to me. The questionnaire contained items focused on socio-demographic characteristics and other variables related to the investigated issue.
The obtained data were processed using descriptive statistics, while the results were presented in the form of frequencies, percentages, averages and standard deviations. Within binary inductive statistics, relationships between variables were assessed by Spearman's correlation. The obtained data were processed in statistical software SPSS25 and MS Excel.
Analysis of the performance motivation level of nurses
Through the four dimensions of the DMV questionnaire, which characterize the motive of work performance, we analyzed the ways in which nurses approach the fulfillment of their work duties (Table 1). The highest average value of the score (M = 4.02) was recorded in the aspect of perseverance at work, which indicates a high level of work engagement of nurses. Respondents mostly agreed with statements such as: I do more than I originally set out to do, when I start a task, I strive to achieve quality results, or when it comes to demanding work tasks, it is difficult for me to give up on completing them. The overwhelming response "often applies to me" indicates a significant degree of persistence in work behavior.
A relatively high average score (M = 3.97) was also found in the aspect of aspirational level, while in this case also the respondents' agreeable answers dominated. This result indicates that nurses identify with the statements directed towards achieving goals, accepting responsibility and placing high demands on their own work performance, such as: I consider it important to achieve a certain position in society, I do not avoid work associated with responsibility or I make high demands on my work.
Positive average values were also recorded in the other two dimensions of the questionnaire, namely in the aspect of performance behavior (M = 3.95) and in the aspect of time orientation to the future (M = 3.75), which points to predominantly positive attitudes of nurses towards performance-oriented statements.
Overall, it can be concluded that the investigated group of nurses shows significantly high performance motivation, as the overall average score for all aspects of the questionnaire reached a value of 3.92. This result indicates that the respondents in most cases answered the items of the questionnaire in the affirmative, while the option "often applies to me" was the most frequently chosen answer.
Table 1 Analysis of the level of performance motivation of nurses
Analysis of the relationship between performance motivation and the age of nurses
The phenomenon of population aging and the relatively high average age of nurses in Slovakia was one of the stimuli that motivated us to investigate the relationship between performance motivation and the age of nurses. In the research, a statistically negative significant relationship was found for the aspect of time orientation to the future p = 0.005 (table 2). The results point to the fact that nurses' orientation to the future in their work decreases with increasing age. Against the background of the aging of the population and the relatively high average age of nurses in Slovakia, we considered it relevant to analyze the relationship between performance motivation and the age of nurses. This demographic trend represented a significant impetus for the implementation of the subject analysis. The results of the research showed a statistically significant negative significant relationship (r = -.277) in the aspect of temporal orientation to the future, while the value of p = 0.005 (Table 2) indicates a significant connection between the investigated variables. The findings indicate that as nurses age, their orientation to future goals and perspectives in the work area decreases. These results point to the fact that older nurses can direct their work motivation to a lesser extent towards long-term goals and plans, which may be related to professional saturation, changes in career expectations or the approaching termination of active work.
Table 2 Analysis of the relationship between performance motivation and the age of nurses
Analysis of the relationship between performance motivation and nurses' education
The analysis of the relationship between performance motivation and the level of education achieved by nurses did not show any statistically significant relationships, while the obtained results are presented in Table 3.
Table 3 Analysis of the relationship between performance motivation and nurses' education
Analysis of the relationship between performance motivation and the length of practice of nurses
The length of professional experience can represent an important factor affecting performance motivation in the work environment. However, the analysis of the relationship between performance motivation and the length of practice of nurses in our research did not show any statistically significant relationships, which is documented by the data presented in Table 4.
Table 4 Analysis of the relationship between performance motivation and the length of practice of nurses
Discussion
A high score of persistence at work (M = 4.02) and aspiration level (M = 3.97) shows a strong performance orientation – above-standard effort, accepting challenging tasks and high demands on the quality of work. It corresponds to the construct of DMV/LMI questionnaires, where perseverance, purposefulness and preference for demandingness belong to the core of work performance motivation (Testcentrum Hogrefe, 2011, Sedláková, Knapová, 2017). The negative relationship of age with temporal orientation to the future (r = -.277, p = .005) is consistent with socioemotional selectivity theory (SST), which points to the fact that with age, motivational emphasis shifts from long-term, cognitive goals to emotionally and currently significant goals (Carstensen, Isaacowitz, Charles, 1999). In a work context, Future Time Perspective (FTP) is strongly negatively associated with age and mediates relations to motivational and behavioral outcomes (Henry, Zacher, Desmette, 2017, Kooij, et al., 2018). The average age of nurses in Slovakia has been growing for a long time and the structure is shifting to higher age categories, which increases the risk of personnel shortage by 2030 (Megyesiová, 2022, Kober, Siska, 2022, Employment Institute, 2024). WHO's global frameworks emphasize the need for investment in education, jobs and leadership to sustain the workforce (WHO, 2020). Undetected statistically significant relationships between performance motivation and education or length of experience can be explained by the homogeneity of the sample (type of facilities, qualifications) and contextual sensitivity of motivation, the literature reports heterogeneous findings across studies and conditions (Baljoon, Banjar, Banakhar, 2018).
Motivation and performance are supported by the elements of the work environment (autonomy, support, fair remuneration) and the behavior of leaders; systematic reviews confirm the direct and indirect influence of leadership on the performance and motivation of nurses (Alsadaan et al., 2023). In older workers, engagement may increase due to better emotion regulation, although FTP narrows - in practice, motivation is more based on the "here and now" (quality of care, relationships) (Mori et al., 2024).
Conclusion
This cross-sectional study provided a comprehensive picture of the performance motivation of nurses in Slovak healthcare facilities. Respondents showed a strong performance orientation, especially in the dimensions of persistence at work and aspiration level, which supports the interpretation that they accept challenging tasks, set high standards and strive for quality results. From the point of view of age, a negative relationship to time orientation to the future was confirmed, which means that with increasing age, nurses' motivation is based on proximal goals and quality relationships rather than on long-term oriented career plans, which must be taken into account when designing intervention measures and personnel policies. Associations of performance motivation with education and length of practice were not demonstrated in our sample. This result is in line with heterogeneous findings in the literature, where motivation is shaped by personal characteristics, especially by organizational conditions and the quality of leadership.
Author: PhDr. Valéria Parová, PhD. Pavel Jozef Šafárik University, Faculty of Medicine, Institute of Nursing
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