leadership st les plus ob satis r action equa i productivity Helen is a 50-year-old staff nurse who has worked in the operating room for almost 30 years. During her childhood, her family lived in Pennsylvania where her father was a coal miner. She came from a family of nine chil- dren. One sister was chronically ill and needed constant medical supervision. Be- cause of the size of the family and her sis- ter's illness, it was necessary for Helen, at a young age, to find a job to assist with meet- ing the family's basic needs for food and clothing. During her childhood, survival was dependent on working and to work was a very important value.

Angie, a 24-year-old, has worked as a staff nurse for three years. Her family background is quite different. Although her father is also a coal miner in Pennsylvania, she comes from a family of two children, and there was suffi- cient money to feed and clothe the family. Angie did not need to work to assist with the family's basic needs. She did, however, have a job in an ice cream store to make spending money for herself. She worked because she wanted to, not because she had to. She had a choice.

Helen and Angie represent two kinds of workers in the operating room today.

As an operating room supervisor, do you wonder how to motivate staff members with such diverse backgrounds? Have you been

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comparing older and younger staff members, trying to determine how to "turn on" each group? It might help you and your staff to look at the relationship between leadership styles, job satisfaction, and productivity.

The OR staff is a composite of individuals with a variety of backgrounds working for different reasons. Therefore the director, supervisor, 01 head nurse cannot consider the staff as one group and expect them all to be motivated to do a particular job effectively and efficiently. As a supervisor, to maximize staff performance, you must look critically at your style of management and perhaps change it, rather than attempt to change the employee's behavior.

Likert describes four basic styles of man- agement: explorative, authoritative, consulta- tive, and participative.' Many social psychologists contend that in most situations, the participative style produces or results in the highest performance and job satisfaction.

Operating room staff members respond favorably to experiences in which they feel they are receiving support from management and making a contribution to the organiza- tion. They need to feel a sense of importance and personal worth. Conversely, staff mem- bers who are threatened or who feel a loss of dignity will react unfavorably to these experi- ences. Within the job situation, each person needs to have a feeling of accomplishment and a place and purpose in the undertaking.

When an employee presents a problem she believes is legitimate, the supervisor who allows that person to participate in solving the problem makes the person feel important

AORN Journnl, April 1977, Vo l25 , No 5 851

and of personal worth. The problem may concern the number of times instruments are left out of trays and have to be individually sterilized. The staff member who has an idea for solving this problem and is allowed to try it is highly motivated to contribute to the efficiency, ie, productivity, of the operating room.

Many times supervisors tend to treat staff members as children who need a chain of command, narrow span of control, task specialization, and constant supervision. When this occurs, the needs of individuals are not met because this type of manage- ment does not allow for flexibility or modifica- tion. The supervisor has difficulties working with and managing the staff.

The challenge for the supervisor is to look at an individual’s potential as something to be continually actualized. Most supervisors are familiar with Maslow’s hierarchy of needs-physiological, safety, love, esteem, and self-actualizatio-which are arranged in a hierarchy of prepotency.2 The theory suggests that man’s wants are a function of his pattern of need satisfactions in the hierarchy. If basic needs are not satisfied, man does not progress to higher level wants. Supervisors have a responsibility to consider what needs of individual staff members are unsatisfied and use those needs as levers for motivation. In the past, the family has been the primary source for satisfying the need for love and social needs: however, because of the radical change in the social structure, this is no longer true. To many, the work envi- ronment has become the primary source for social satisfaction. For most people, the desire for communication, support, and friendship with associates on the job during working hours has become more important than additional money that might be earned. In Angie’s case she has a real need to feel a sense of belonging with her coworkers while Helen has a large family unit where her needs for socialization are met.

McClelland and others have contributed to the psychology of management by their re- search on socially acquired motives such as achievement, affiliation, and power.3 Operat- ing room staff members who are high achievers like situations where they take personal responsibility for finding solutions to

problems, setting their own goals, and taking calculated risks. They also want concrete feedback on how well they are doing.

“People who need people,” those with the affiliation motive, are more concerned with the quality of their personal relationships. Instead of being task oriented like the achievers, their thoughts are on relationships with other people. These are the staff mem- bers who try to project a favorable image in interpersonal relations, smooth out disagree- able tensions in meetings, and help and sup- port others.

Other staff members may strive for power-control and influence. These indi- viduals think about how to obtain and exer- cise power and authority. The motivation for power is not necessarily an undesirable trait. Power can be positive, and if a supervisor or staff member exerts power that is persuasive and inspirational, she may evoke this in others.

The participative supervisor helps the staff in the operating room form goals and allows them to obtain those goals by aiding their expression of strength and competence. The more clearly a supervisor understands what behaviors lead to improving performance, the more carefully she can consider who is likely to behave that way and what administrative and organizational conditions will help stimu- late that behavior.

Supervisors have had to come to grips with the concept that their staff includes people who seek their own employment, bargain on an open market, and make choices about where they want to work. Herzberg decided he would try to find out what actually motivated people to work.‘ Al- though his work has been criticized, his find- ings are worth considering when trying to increase productivity. He lists five factors as strong determinants of job satisfaction:

1. recognition-the act of someone speaking, taking notice, praising, blam- ing, or in some way letting us know they exist

2. achievement-the successful comple- tion of a job, solution to a problem, or in some way seeing the results of one‘s work

3. work-a potential for growth within the organization by climbing the ladder

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from one job to another as your skills and ability grow responsibility-those factors that show that the person can assume responsi- bility for his work or for the work of others or that he can assume new responsibility as indicated advancement-an actual change in position or status, or a transfer from one part of the company to another with increased opportunities for work.

These job satisfiers are identified as motivators since these factors result in an individual growing and seeking personal growth. On the other hand, Herzberg iden- tified job dissatisfiers or what he terms “no job satisfaction.” He also calls these hygiene factors because they serve only to make the environment more acceptable but do not serve as motivators. For most operating rooms, the hygiene factors listed below are the areas of most complaints and dissatisfac- tion.

1. company policy and administration 2. supervision 3. salary 4. interpersonal relations 5. working conditions. Looking at Helen and Angie, what are their

primary motivators? Helen, who grew up dur- ing the depression, sees work as a basic value and is rewarded if she feels she did a job well. In contrast, Angie is more con-

cerned with recognition. When her supervisor commends her or her colleagues support her on a new project, she feels motivated to make an extra effort.

Factors that contribute to individual growth are important motivators. To increase pro- ductivity, the needs of individuals must be considered along with styles of management. This does not mean that the staff should be totally free within an organization. Both supervisors and staff must “give a little” to profit from each other. A cooperative focus- ing on the needs of both the employees and the operating room will create a more effec- tive and smoother functioning OR. Staff within the operating room are striving toward self-actualization. Inherent is the idea that the individual must, in his self-actualizing, strive to meet the needs of the operating room as well as his own.

Julie Kneedler, RN, EdD Assistant director of education

Notes 1. Rensis Likert, The Human Organization: Its

Management and Value (New York: McGraw-Hill, 1 967).

2. A H Maslow, Motivation and Personality (New York: Harper and Row, 1954).

3. D C McClelland, “The two faces of power,” Journal of International Affairs 24 (1 970) 29-47.

4. Frederick Herzberg, Work and the Nature of Man (Cleveland: World Publishing Co. 1966).

New AMA edition of drug evaluation book The third edition of AMA Drug Evaluations, the American Medical Association’s compendium of information about drugs for the physician, will be available in the spring.

Completely revised, updated, and expanded, the book contains more than 1,300 pages of essential data for drug-prescribing or dispensing. It evaluates most available drugs and compounds and recommends dosage ranges. Included are generic and proprietary names, structural formulas, indications, contraindications, and adverse reactions. More than 700 diagrams, 20 tables, 2 indexes, and an appendix on drug interference with laboratory tests are included.

Included in the 87 chapters are evaluations of 61 new drugs and dosage forms and expanded information on some drugs under study but not yet on the market. Information is included on timed-release preparations, labeling, use of drugs in pregnancy, prescribing controlled psychotropic drugs, and interactions.

The book is a joint scientific effort of the AMA Department of Drugs plus a number of outside contributors. Text was subjected to critical review by several hundred clinical consultants and by an expert panel of 60 recognized authorities appointed by the American Society for Clinical Pharmacology and Therapeutics.

The book is available from Publishing Sciences Group, Inc, 545 Great Rd, Littleton, Mass 01 460.

a54 AORN Journal, April 1977, Vol25, N o 5