Human Resource Management论文模板 – The Role of Recognition and Appreciation on the Performance of Registered Nurses in Middle-Level Hospitals in Saudi Arabia


1.1 Research Context and Rationale

The healthcare sector has been identified a number of studies as one of the key support sectors to the welfare of people and economic development across the world (Acton, 2013). As such, effective service delivery in the sector remains a critical success factor for all the other sectors in the economy. Globally, research has shown that low employee motivation arising from human resource management (HRM) practices adopted in organisations has been responsible for low performance at individual and organisational levels (Henryhand, 2011). In most developing countries where resources are constrained, public hospitals face the challenge of insufficient number of nurses (Donoso et al., 2015). Considering the labour-intensive nature of services offered in healthcare sector, performance in healthcare organisations is fundamentally influenced by ‘how motivated’ the healthcare workers are (Mohamud, 2015). As a result of the increasing economic turbulence, not only in the developing economies but also across the globe, the need for the use on non-financial incentives to motivate healthcare workers in order to revamp their performance has been critical.

Staff recognition and appreciation are pointed out by Henryhand (2011) as among the most popular incentives that healthcare organisations in the developed countries use to drive motivation and foster performance of nurses and other medics in the healthcare sector. When employees are appreciated and their efforts recognised, they feel nourished and valued; and subsequently leading to the development of positive morale towards their job. According to Mosley & Irvine (2014), appreciation and recognition of employees is mostly non-financial, and this helps organisations to establish sustainable staff motivation programs that are not influenced by the financial performance of the organisation. For nurses, various recognition and appreciation programs in the American healthcare system have been widely adopted including Nurses Week Celebration, MAGNET Awards, Thank You Card, Appreciation Letter Received from Patient Relations Department, and AMSN Awards among others. The use of non-financial incentives has also been applauded by Yoder-Wise (2013) for its ability to nurture long-term staff motivation, as it contributes largely towards intrinsic motivation of employees.

In Saudi Arabia, the public healthcare system faces the challenge of resources constraints, which has led to the overworking of the healthcare workers in such organisations (Oxford Business Group, 2014). Registered Nurses (RN1) in particular have reportedly been the most affected, especially in middle level hospitals. This is because average number of nurses in such hospitals is less than 40 per hospital, against the expected average number of 50 nurses per every middle level hospital. One of such hospitals is Hospital C, which has only 31 nurses, against the average number of in-patients count of 85 per day. This is an implication that, most of the nurses are often faced with fatigue due their low count and subsequently high flow of patients in the hospital. Under these circumstances, the need for the human resource manager in the hospital to adopt non-financial staff incentives to motivate and promote the commitment of nurses to work diligently to achieve their performance targets is critical. With limited research on how staff appreciation and recognition affect the performance of RN1, especially in developing countries like Saudi Arabia; this study is expected to provide a springboard in understanding how staff recognition and appreciation for RN1 at Hospital C affect their overall performance, despite the challenges of resources constraints they face.      

1.2 Research Aim and Objectives

The purpose and aim of this study is mainly to investigate the impact of appreciation and recognition of registered nurses (RN1) in Hospital C in Saudi Arabia on their level of performance. The mediating role of staff motivation will also be brought into brought into focus in this investigation. On the basis of this research aim, the following objectives will be adopted to guide the researcher in this investigation:

  1. To identify the various ways of recognition and appreciation for RN1 in Hospital C
  2. To determine the relationship between recognition and appreciation and motivation level for RN1 in Hospital C
  3. To determine the impact of staff recognition and appreciation on the performance level of RN1 in Hospital C
  4. To determine the mediating role of staff motivation on the relationship between recognition and appreciation of RN1 and their performance outcomes in resource-constrained environment       


2.1 Employee Recognition and Appreciation

Despite their relatively long existence in academic realms, the concepts of employee recognition and appreciation seem to be underexplored (Armstrong, 2012; Henryhand, 2011). According to Donoso et al. (2015), the relatively low staff recognition and appreciation coverage in academic literature can be attributed to their unclear definitions. Though some researchers have been using the two concepts interchangeably, both recognition and appreciation in organisational behaviour are distinct. According to Human Resource Council (2015), employee recognition is “the acknowledgement of an individual or team’s behavior, effort and accomplishments that support the organization’s goals and values” (p. 1). On the other hand, appreciation is the acknowledgement of an individual or a team based on its unique characteristics, but not necessarily based on performance alone (Henryhand, 2011). As such, the two concepts differ in the sense that employee recognition is mainly attributed to the performance of an individual or a team, whereas appreciation is mainly based on the value of the individual/group. As such, it can be argued that individuals who are not top performers can be appreciated based on their personalities and unique character traits within the organisation with regard to the values cherished in the organisation.

Both recognition and appreciation can be formal or informal practices/programs aimed at supporting employees to remain focused towards the organisation’s goals and objectives (Kagan & Evans, 2013). Formal recognition and appreciation programs are that are embedded on the organisation’s official structures aimed at promoting employees’ morale and motivation in their job; whereas informal recognition and appreciation are mainly spontaneous, personalised, and meaningful gestures given by managers/supervisors immediately when an employee does something outstanding/valuable to the organisation (Kaiser & Ringlstetter, 2011; Mohamud, 2015). In a hospital setting for example, formal recognition or appreciation can be in the form of ‘nurse of the week/month/year’, whereas an information recognition or appreciation can be a spontaneous congratulatory message towards an employee after a successful medical procedure. Research has shown that, both formal and informal recognition and appreciation of employees are useful in equal measures; and hence a balance between them ought to be established by the leaders in the organisations (Laschinger & Fida, 2014; Ashton, 2013). This is because the frequent nature of informal recognition and appreciation makes employees energised in their day-to-day activities, whereas formal recognition programs makes employees feel valued and their efforts recognised by the entire organisation; and this contributes largely towards employee loyalty, general morale, and overall productivity in their job.     

2.2 Performance Measurement in the Nursing Profession

Measuring performance in the healthcare sector has been faced by a wide range of complexities ranging from the accuracy of measurement since health care services are mostly intangible (Buchbinder & Shanks, 2011; Staplers et al., 2015). Nonetheless, the National Department of the Nursing Quality Indicator (NDNQI) has been pointed out by a number of researches as one of the key performance indicators of nurses (Barnsteiner & Disch, 2012; Donoso et al., 2015). Among the key issues highlighted in the NDNQI tool include the patient satisfaction results, nursing documentation report, patient fall survey results, and the hygiene survey results among others. For outpatient cases, the timeliness in response to the patients’ needs and accuracy of care administration offered to the patients are as well considered by Sheridan (2011) to be critical performance indicators of nurses in hospitals. On the other hand, in the in-patient contexts, nurses performance can be measured in the quality of care given to the patients where timely administration of medicine, the level of hygiene conditions in the patient’s area, and the general courtesy that nurses treat patients with play a critical role in describing the overall service quality offered to the patients by the nurses.    

2.3 The Impact of Recognition and Appreciation on the Performance of RN1s

The ultimate goal of recognising and appreciating employees is mainly to encourage them to continue with the good work, while also mobilising others to emulate the behaviours of the recognised and appreciated individuals (Robbins et al., 2011; Henryhand, 2011). This implies that, staff recognition and appreciation motivates individuals to work harder towards a common goal, both to the individuals and bystanders within the organisation (Mosley & Irvine, 2014). In the nursing context, when nurses are recognised because of their outstanding performance, a sense of commitment develops among the nurses in order to enable them to continue with the ‘good job’ that has led to their recognition. The overall impact of recognising nurses as pointed out by Mervi & Sanna (2015) is to push them further to endure the challenges, if any, in their job so as to maintain their performance or even do better. As such, it can be argued that staff recognition and appreciation have direct positive impact on the performance of RN1s; and hence the following hypothesis is formulated to investigate this relationship in this study:

H1: Recognising and appreciating RN1s has positive impact on their general performance in their areas of work;

Research has shown that, the aspect of motivation is the bottom-line of positive behaviours among employees (Leary et al., 2013; Kagan & Evans, 2013). According to Laschinger & Fida (2014), when employees are recognised and appreciated, they develop a sense of motivation which further energises them to work harder to achieve better outcomes. As such, it is evident that employee motivation can be a critical mediating factor on the relationship between recognition and appreciation, and performance of nurses. This is based Kaiser & Ringlstetter (2011) ideas who argued that when employee are appreciated and recognised for their outstanding performance, their morale is boosted leading to high level of motivation in their job, which in return enhances their increased performance. As such, the following hypothesis will be investigated in this study:

H2: Employee motivation mediates the relationship between recognition and appreciation of RN1 and their performance outcomes;

H2a – Recognising and appreciating RN1s fosters their motivation;

H2b – Increased motivation of RN1s enhances their performance    

In the light of the above discussions, figure 1 below shows the conceptual framework that the research anticipates adopting in this study. Essentially, the researcher considers the recognition and appreciation of RN1 as the independent variable(s) (IV), while motivation is the mediating variable (MV); whereas ‘performance outcomes’ of the RN1s is the dependent variable (DV).  


3.1 Research Philosophy

The research philosophy defines the researcher’s orientation when conducting a research study based on the nature of knowledge that fits within the identified research problem (Simon, 2011). In essence, the research philosophy describes the researcher’s world of view of the research problem, and hence helping to identify nature of the data required to adequately answer the research problem (Saunders et al., 2012). While there are a wide range of research philosophies available to researchers, the researcher in this study considers positivism epistemological philosophy to be the most appropriate. This is because this study aims at testing the relationship recognition and appreciation, and performance outcomes of RN1; and hence since positivism philosophy aims at leveraging scientific tests to determine the relationship between two or more variables where conclusions are logically established (Habib et al., 2014). Unlike other philosophies like interpretivism which mainly relies on the identification of how social behaviours are constructed through social patters of interaction (Crosby et al., 2011); positivism philosophy is more scientific, and enables the researcher to be in a position to empirically establish the relationship between the research variables more accurately.    

3.2 Research Strategy

Based on the nature of the quantitative research design is preferred, and hence case study strategy considered being the most appropriate. This is because only quantitative data will be effective based on the nature of the research philosophy that will be adopted, and hence in order to allow for comprehensive coverage of the research problem in a more objective manner the researcher considers case study strategy to be effective (Simon, 2011; Yin, 2013). Since case studies only focus on a single or limited research subjects on a particular research phenomenon, extensive coverage of the key aspects of the research phenomenon is enabled (Saunders et al., 2012). Unlike survey where data is collected from diverse research sample, case study enables the researcher to mainly focus on a manageable research subject so as to first understand how a particular research phenomenon influences the research subject(s) before expending to a larger context, and hence enabling a more focused approach throughout the research process.

3.3 Research Participants and Sampling

In this study, the research will mainly focus on the healthcare sector of Saudi Arabia where data will mainly be collected from a middle-level hospital in the country, named Hospital C. All the 31 RN1 in the hospital will be selected for participation in this study, and hence only a sample of 31 will be used for analysis in this study. As such, purposive selection strategy will be employed to collect data in this study, since only RN1s will be eligible participants; and hence because of their relatively low count in the hospital, an inclusive sampling strategy is preferred in order collect the opinions of all the eligible participants in the organisation.  

3.4 Data Collection and Analysis

In this study, data will be collected using a self administered questionnaire. The process of designing the questionnaires will mainly be guided by the research objectives and existing literature in order maintain validity of the data collection tool. The questionnaire design will mainly be structured with closed-ended questions, in order to make it easier to quantify the results obtained, and statistically analyse the data to test the relationship between the variables investigated in this study (Habib et al., 2014). A pilot test with a sample of 5 RN1 will be conducted in order to determine the validity of the questionnaire. Since only quantitative data will be collected in this study, data will be analysed using Statistical Package of Social Sciences (SPSS 19.0) software. The research hypotheses will be tested using Pearson’s Chi-square, Correlation and multiple regression tools.    

3.5 Validity and Reliability Issues

Research validity measures how accurate a data collection tool collects relevant and accurate data to answer the research objectives (Saunders et al., 2012). In order to ensure the validity of the data collection tools, the researcher was keen to design the questionnaire based on the research objectives and the existing data. Much of the focus was given on designing questions that were directly related to the research aim and objectives. In order to pre-determine the validity of the questionnaire, a pilot study will be conducted and any necessary revisions made. In order to test the reliability of the measurement tool, Cronbach’s alpha will be tested. 

3.6 Ethical Considerations

Throughout the research process, the researcher will ensure a high degree of ethical conduct. First, the researcher will ensure that the participants’ are informed on the nature of the study and their rights are well communicated before the actual data collection. Moreover, anonymity of the participants will be ensured as part of ethical measures in this study by ensuring that no actual names or contact details are shown in the analysed data. In addition, the confidentiality of the participants by ensuring that the collected data will mainly be used by the researcher for the proposed study only, and no third parties will be allowed to access it.    


The proposed study is expected to go for a period of 12 weeks – as shown in the Gantt chart shown in table 1 below.

Table 1 – Gantt chart

TaskJan 20Feb 02Feb 10Feb 18Fe 26Mar 03Mar 10Mar 17Mar 24Mar 31Apr 06Apr 15
Commencement of the research/Proposal development            
Writing the literature Review            
Designing of data collection tool/questionnaire            
Asking of Permission/Data collection            
Analysing the collected data              
Writing the other chapters of the dissertation            
Submitting the first draft of the dissertation            
Revising the draft based on supervisor’s comments            
Submitting final report            


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