0011-MOTIVATION IN THE NURSING PROFESSION: AN ISLAMIC PERSPECTIVE
Paper presented at the 4th International Nursing Conference held in Brunei 19-22
November 2000 by Prof Dr Omar Hasan Kasule, Sr. MB ChB (MUK), MPH, DrPH (Harvard); Deputy Dean for Research and Post-graduate
Affairs, Kulliyah of Medicine, International Islamic University, Kuantan, MALAYSIA EM: email@example.com
1.0 CONCEPT and METHODS OF MOTIVATION IN ISLAM
A. DEFINITION OF MOTIVATION
WHAT IS MOTIVATION?
Motivation explains why individuals behave the way they do. Motivation is bringing out the best in people. Motivation
is an internal drive, a conscious voluntary choice, a positive attitude to work, with purpose and high expectation of success.
Motivation is inside, its outward manifestation is behavior of the worker: a strong sense of direction in the work, persistence
in face of obstacles and challenges, and intensity of performance.
COMPONENTS OF MOTIVATION
Motivation has three components: (1) instincts: innate biological determinants of behavior (2) drive: an aroused
state that occurs because ofconvictions, determination, or physiological need
(3) incentives: external stimuli in the form of rewards or even punishments.
MOTIVATION vs MANIPULATION
Motivation should not be confused with manipulation. Motivation is internal whereas manipulation is external. Motivation
primarily is follower satisfaction whereas manipulation is for the sole pleasure of the leader to the detriment sometimes
of the follower.
HIGHLY MOTIVATED INDIVIDUALS:
Highly motivated individuals manifest some common characteristics: clarity of vision and objectives, strategic
and tactical plans for achieving objectives, high expectancy, energy, drive and self confidence, need for responsibility and
control, strong communication skills, taking risks, accepting Correction/criticism, want for recognition, doing interesting
work, high expectancy, having authority
TYPES OF MOTIVATION
Intrinsic and extrinsic motivation: The best motivation is self-motivation. The role of leaders is to facilitate
the process. Superior performance results when the inner person is influenced positively: his thinking, his self-esteem and
his commitment. Motivation is individual. What motivates one person may not motivate another one. What motivates a leader
may not motivate a follower. Achievement motivation is when the basic drive is to succeed regardless of the rewards or punishments.
Both intrinsic and extrinsic motivation are used. Intrinsic motivation is needed for competence and self-determination. Extrinsic
motivation is from the environment especially rewards
Real vs reactionary motivation: Some highly motivated people in one area may be trying to cover up failures
elsewhere. Reactionary motivation is temporary.
COMMITMENT, ikhlaas & INTENTION, niyyat IN WORK
Commitment, ikhlaas, was described in the Qur’an (p. 80 2:139, 4:146, 6:90, 7:29, 10:72, 11:29, 11:51,
12:24, 12:4-10, 15:40, 19:51, 25:51, 26:109, 26:127, 26:145, 26:164, 26:180, 29:65, 31:32, 34:47, 36:21, 37:40-49, 37:74,
37:128, 39:160, 37:169, 38:2-3, 38:83, 38:86, 39:11, 39:14, 40:14, 40:65, 42:23, 98:5). Ikhlaas is expressed
in the intention, Ikhlaas al niyyat (KS 66). Work is the consequence of the intention.
Every work is rewarded according to the intention behind it, innama al a’amaal bi al niyaat (KS 93).
Every person is rewarded according to his/her niyyat, li kulli imri ma nawa (KS 552). The amount of reward is commensurate
with the intention, iqaau al ajr ;ala qadr al niyyat (KS 552). On the day of resurrection people will be resurrected
with their intentions, yukhsharu al naas ‘ala niyyatihim (KS 553). Any work without niyyat is not considered
The niyyat must be constant and consistent throughout the whole period of performance until completion.
Start must be early and serious, baadiru bi al ‘amal (KS 93). Work is best judged by its last stages, al ‘amal
bi al khawatiim (KS 93). The best of work is that which is consistent and continuous, khayr al ‘amal adwamuha
(KS 94). In all performance, the human performs that which he is capable of even if the niyyat envisaged more (KS 94). Work
is a test for the human, ibtilaau al insan bi al ‘amal (p 839 7:129, , 11:7, 18:7, 67:2).
Work is responsibility (p 849-850 2:134, 2:139, 2:141, 2:234, 2:240,2:281,
2:286, 3:25, 3:161, 4:66, 4:111, 6:164, 7:155, 7:173, 10:41, 14:51, 21:23, 24:11, 26:112, 26:168-169, 26:216, 28:55, 34:25,
40:12, 42:15, 45:22, 52:21, 66:11, 74:38). The Qur’an emphasizes the importance of work, al hath ‘ala al ‘amal
(p 840 6:135, 9:105, 11:93, 11:121, 18:110, 34:11, 34:13, 39:39, 41:5, 41:40, 67:15). There is reward for work done, jazaau
al ‘amal (p 840 2:85, 3:30, 6:132, 11:15, 11:111, 16:93, 16:111, 18:49, 21:59, 23:63, 24:64, 36:54, 37:39, 39:70, 41:46,
45:15, 45:28, 46:19, 47:33, 47:35, 49:14, 52:16, 52:21, 58:6-7, 64:7, 6:135, 9:105, 11:93, 11:121, 18:110).
Humans have freedom to choice in the work that they do, hurriyat al insaan fi al ‘amal (p 841 4:66,
17:18-19, 17:84, 41:40, 73:19, 74:37, 76:29, 78:39, 81:28, 92:4-10). Work can be good, ‘amal hasan (p 841 9:121,
16:96-97, 24:38, 29:7, 39:35, 46:16). Work can also be bad, ‘amal sayyi (p 841 3:28, 3:30, 5:90, 7:28, 11:78,
12:10, 12:32, 12:69, 21:68, 21:74, 26:74, 85:7). Some people try to decorate bad work to make it appear good, tazyiin al
‘amal al sayyi (p 842 6:108, 6:12, 8:48, 9:37, 10:12, 16:63, 18:103-104, 27:4, 27:24, 29:38, 35:8, 40:37, 47:14).
Bad work s condemned, dhammu al ‘amal al sayyi (p 843 2:282, 5:62, 5:66, 5:79, 9:9, 28:15, 29:4, 58:15, 60:1,
63:2, 63:9). The reward for bad work is a bad one, jazau al ‘amal al sayyi (p. 842 2:231, 3:30, 4:30, 4:123,
7:147, 7:180, 10:106, 16:28, 16:33-35, 25:68, 27:84, 27:90, 28:84, 29:55, 30:41, 31;23, 32:14, 34:33, 40:40, 41:50, 45:33,
53:31, 66:7, 83:36, 99:8). Humans must repent from bad work, al taubat min al ‘amal al sayyi (p 842-3 2:231,
3:30, 4:30, 4;123, 7:147, 7:180, 10:106, 16:28, 16:33-35, 25:68, 27:84, 27:90, 28:84, 29:55, 30:41, 31:23, 32:14, 34:33, 40:40,
41:27, 41:50, 4:33? 53:31, 66:7, 83:36, 99:8).
Good work reflects underlying faith, al ‘amal al saalih min al imaan. Goods work is a criterion of
superiority among humans, al tafadhul fi al ‘amal al saalih (p 844 38:24, 38:28, 40:58, 45:21, 98:7, 103:2-3).
Good work is rewarded in the hereafter, thawaab al ‘amal al saalih al ukhrawi (p 844-846 2:25, 2:62, 2:82, 2:277,
3:57, 3:136, 3:195, 4:57, 4:114, 4:122, 4:124, 4:173…. 99:7). It is also rewarded on earth, thawab al ‘amal
al saalih fi al duniya (p 846-7 16:97, 18:88, 19:96, 24:55).
Work must be performed with the purest of intentions. Everything including the various organs of the body bear
testimony to good work, shahaadat al a’adha ‘ala al ‘amal (p 843 24;24, 36:65, 41:20). Allah knows
all the work done (p 847-848 2:74 … 99:6).
Working for the purposes of showing off, riyaa, is frowned upon (KS 93, 256). Riyaa is considered shirk asghar
MOTIVATION AND PERFORMANCE:
Leaders need motivation to be able to manage; workers need motivation to be able to perform. Motivation is infectious.
Motivated leaders usually have motivated followers. Motivated peers are surrounded by motivated individuals. The leader must
understand what motivates people to be able to get the best from the followers under him. This is usually not an easy task
because the followers may himself not be able to tell what motivates them. Most people with average abilities can be super
producers if motivated well. Motivation should not be confused with performance. A highly motivated person may not perform
well because of mistakes, lack of resources, or technical skills. Turning motivation into performance is a challenge, it requires
setting objectives and goals, abilities and skills, training, and resources. Performance is affected by the individual's capacity
to perform, the willingness to perform, and being given an opportunity to perform. Job satisfaction is how well a worker likes
the job. High job satisfaction is directly related to high motivation. The relation between level of motivation and success/achievement
is not always linear. Motivation is low at the start of a difficult task when the feeling is 'why waste effort on project
likely not to succeed. When the project gets under way and results begin to appear, motivation level is high because of concrete
results realized. Motivation is low towards the end of the project when things are moving well. Thefeeling is 'why bother when all is going so well!'
THEORIES OF MOTIVATION:
Many of the theories on motivation in the literature reflect the West European and American world-view and would
not be applicable to Muslims. Muslims find their motivation in their religion and their cultural heritage. Any approach to
motivation that ignores this will not succeed. The Prophet (PBUH) taught that every human endeavor is an act of worship and
charity. Thus a Muslim while working knows she is worshipping her Lord and this is a powerful motivator in itself irrespective
of any material gain. The concept of ihsaan, strife towards excellence, is a great motivator for a Muslim. A Muslim
looks at the salary and other material benefits as a means to enable him feed, clothe, and house herself and her family so
that she can devote her energy to the work. She does not look at them as a just return for her labor. Her labor is worship
and only Allah can recompense for it. There are aspects of Muslim character that affect motivation: sharaf (dignity
& honor, fear of losing face, shame for self and family), thawab (reward in the hereafter), karam (generosity),
and wafa (fulfillment).
B. METHODS AND TECHNIQUES OF MOTIVATION
Motivation (or de-motivation) can be from the leader, peers, working conditions, or the general environment. Motivated
leaders are powerful motivators. The very process of leading motivates by defining a sense of direction and giving purpose
to the endeavors of the group. Followers are motivated if leaders communicate positive feelings of approval. Motivated co-followers
buoy up the less motivated ones. Approval and positive attitudes by co-followers are very strong motivators. The old saying
that nothing succeeds like success is very relevant here. The higher the probability of success the higher the level of motivation.
Followers get motivated when they see that their efforts are bearing fruit. There are measures that leaders can undertake
to motivate followers positively. A motivated leader motivates. Successful leaders can motivate their followers by clarifying
goals, setting challenging but attainable objectives, use of participatory management that makes the workers feel they are
an important part of the work team. The way a leader deals with followers can motivate or de-motivate them. Respect, recognition,
humane and kind treatment, good 2-way communication are positive motivators. Fairness and justice in an organization are strong
sources of positive motivation. Fairness is based on building trust (sharing information and fulfilling commitments); consistency
in decisions, behaviors and pronouncements; truthfulness; integrity; equitable treatment of all people and justice for all;
respect for others; and following due process. The follower must feel secure about his job and know that as a member of a
work team he will be protected and supported when he encounters difficulties. His basic physiological and psychological or
social needs must be fulfilled so that he does not have to worry about them. The type of work assigned can motivate. The follower
motivated by work that is challenging and meaningful; has opportunities for advancement, learning and personal growth; provides
responsibility and independence; and gives job satisfaction.
Worries, lack of self-confidence, low self-esteem, and low self-worth are associated with low follower motivation.
Negative opinions in the work place, poor working conditions, poor leadership, inequity, and injustice are negative motivators.
reinforcement can be positive or negative. Positive reinforcement is through appreciation, reward and praise. A
worker who knows that his work is useful and is appreciated will be highly motivated. Reinforcement can be continuous, or
at fixed intervals, or at variable intervals. Reinforcement at variable intervals is more effective because of the expectancy
it generates. Negative reinforcement is reprimand. A worker may perform well to avoid a reprimand. However this approach will
fail in the long run.
AJR AS A MOTIVATOR
A good act is rewarded 10-fold (KS 93).
MATERIAL REWARDS AS A MOTIVATOR:
Expectation of a just reward (material or non material) for work well done is a motivator. Need-based motivators
can be ranked. Respect comes first followed by security, success, and independence. Little financial compensation is not in
itself a de-motivator unless it is viewed as not being equitable. The gap between the lowest and the highest paid should not
be flagrantly large. Financial rewards should be directly related to the effort expended or the contribution to the organization.
The use of material rewards as a motivator should be put in proper perspective. People work because they believe not because
they receive. Once material rewards become the prime motivators, many workers will look for ways (and there are many) of getting
the rewards without putting in the requisite effort. They may pretend to work, lie to their managers, be polite and respectful
to superiors, stroke the egos of leaders to get loved, develop and nurture strategic friendships, give impressions of being
team players, avoid high risk assignments that could expose weaknesses, and generally play the pretending game well. In many
organizations promotions are not a result of documented performance but senior management feeling good about the employee.
You cannot get away with material rewards for no work for long. You can however spend a life-time hopping from one pretense
job to another with eventual loss of self-esteem. When the reality becomes known as it must be, termination is the result.
Rewards can be contingent on certain follower achievements. Intrinsic rewards are task completion, achievement, autonomy,
and personal growth. Extrinsic rewards are salary, benefits, and promotions.
MOTIVATING AN INDIVIDUAL:
motivation of an individual is different from motivation of a group. General measures needed to motivate an individual
include: positive working atmosphere, emphasis on high hopes, opportunities for growth, promoting team spirit, fair rewards,
and setting achievable challenges. Specific measures for motivating an individual are a step-by-step process. Determine the
motivation needs of an individual. Define the desired performance. Link motivation to performance. Provide training, information,
and resources. Then loosen grip and monitor performance with frequent feed-back.
MOTIVATING A TEAM:
a team can be motivated by providing the right working conditions, defining a clear mission, identifying a common
goal and a common identity. The attitude must be positive and the leader must be motivated.
C. MOTIVATION IN THE NURSING PROFESSION
MOTIVATION TO CHOSE A CAREER IN NURSING:
What motivates a student to enter nursing school, will affect her commitment to practice of good nursing. Nursing
is a vocation and success in it requires special aptitude and motivation. Two processes are going on. Pre-nursing school the
character of the student and knowledge base are formed by the schools and society. During nursing school and after graduation,
there are influences from the profession and from colleagues that affect the nurse’s motivation. The motivating factors
range from the idealistic to the pragmatic material rewards. It is difficult to undertake a valid survey research of the reasons
for choosing a medical career. Many students will consciously or unconsciously talk about ultruistic motivation.The real motivators
may be prestige, status, family/peer pressure, and expectation of material rewards. Students are idealistic on entry into
nursing school. Towards the end of their education, clinical students believe that nursing education will enable them to find
a job, enjoy easy life and have a high social status.
The formal education of a physician starts with the elementary school. In the elementary school a child should
learn about morals, Islamic culture, adab and akhlaq, service and feeling for others. Good grounding in the Qur’an
and sunnat is needed at this stage.Ibn Sina started his education very early
at the age of six. He started by learning the Qur’an by heart.Knowledge,
values and attitudes acquired in the elementary stage of education are the basis for later studies in medicine. Thus the future
nurse has a solid base of Islamic culture. Choice of a nursing career fulfils a collective responsibility,fardh kifayat. In some cases it may be individual responsibility, fard ‘ayn, where
there is no other nurse. Families and communities should encourage children to enter the nursing profession where there is
a shortage of medical manpower. The importance of medicine was underlined by Imaam al Shafie when he said: ‘I know of
no discipline of knowledge after knowing halal and haram that is more noble than medicine. He also said that Muslims lost
one third of all knowlege and left it to the Jews and Christians. He regretted the monopoly of medicine by people of the book.
Students should be taught that study of medicine contributes to preparing the ummah’s strength, i’idaad
al quwat and restoring Muslim dignity.
MOTIVATION DURING THE MEDICALSCHOOL:
A question should be asked: do we offer a subject called ‘Islamic Medicine’ to orient the students
or do we change the whole curriculum so that it reflects Islamic values?. The latter choice seems to be the most appropriate.
The student should be taught about the Islamic heritage in methodology and medicine as a motivator for excellence. The achievements
of Muslims in the science of fiqh and hadith methodology could motivate excellent research. The model of the
earlier physicians is inspiring to the young ones. They were encyclopedic and all-rounded in their knowledge. They would lead
prayers in the mosque, go and research on medicine, and may be return to teach Qur’an.The main lesson for the young student is that the ancient Muslim physicians were able to excel while they maintained
their Islamic identity. Islam is not incompatible with excellence in science or medicine. There are several accounts of achievements
by early Muslim medicine written by Muslims and non-Muslims. The Muslims may overstate while the non-Muslims may understate
and in-between lies the truth. Early Muslim physicians excelled in several medical fields. A nursing course is a difficult
undertaking and requires a lot of patience. The Qur’anic story about Musa (PBUH) and the righteous man is very inspiring
to the student who may feel fatigue.
MOTIVATION AFTER MEDICALSCHOOL:
Material motives can not be completely ignored in the name of idealism. A minimum of comfort is necessary for the
practice of virtue. The nurse should be recompensed adequately for her services. Inadequate material rewards often result
into frustration or even brain drain. Incentives for graduates to work in rural or depressed areas or choose unpopular but
necessary specialties lies beyond the control of nursing educators. The nursing school can however maintain motivation for
its graduates by means of continuing medical education programs. The following Islamic concepts are motivating for the nurse:(a) the search for excellence, ihsaan (b) witnessing against other communities,
shahadat ‘ala al naas, which implies that this ummah must lead the destiny of humanity and its members
must excel in work as befits leaders who must set the example for others (c) good deeds, amal salih, is the basis for
al human endeavors by a Muslim. (d) Fulfilling responsibility, amanat in work and (e) placing self-interest below others’
interests, ithaar (hashr 59:9).
D. MOTIVATION and RESPONSIBILITY
RESPONSIBILITY TO THE PATIENT
The responsibility of the physician, mas uliyat al tabiib (KS 339)
Delivery of excellent and affordable care
Working towards ensuring universal access
RESPONSIBILITY TO THE COMMUNITY
A nurse is influential in some sectors of society and can engage in general education, tarbiyyah; enjonining
the good and forbidding evil,amr bi maroof wa nahy ‘an al munkar, leadership,
and advocacy for the poor