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“Competition is not only the basis of protection to the consumer, but is the incentive to progress.”

Herbert Hoover, American President (1874-1964)

“Desire is the key to motivation, but it's determination and commitment to an unrelenting pursuit of your goal—a commitment to excellence—that will enable you to attain the success you seek.”

Mario Andretti

Leaders have a difficult job, because their success rests heavily on the work of others. A leader accomplishes his or her goals and work through subordinates.1 Therefore, one of the keys to successful leadership is motivating subordinates to strive for the same goals as the leader. One way of accomplishing this is through incentive programs, which can be defined as “a formal scheme for inducing someone…to do something.”2

To be successful, nursing leaders in emergency departments (EDs) must master the art of motivation. Utilization of incentive programs is one tool in the cadre of instruments available for this purpose. Although there are many variations to these incentive programs, they tend to be clustered around 4 main themes (Box 74-1). As with any program, each one has its strengths and weaknesses. Nursing leaders must decide which program best suits the department and the factors that require influencing. This may mean choosing one of these programs, initiating 2 or more programs simultaneously, or even combining several of these programs to enhance the strengths of each and minimize the individual weaknesses.

Box 74-1 Common Nursing Incentive Programs

Regardless of which type of program is used, the ED nursing leader must consider impediments to program implementation. One of the major obstacles is the requirement to standardize compensation throughout the institution. Administration and human resources may frown on a financial incentive program, which rewards a single department or even a specific job class within a department without providing equal rewards to other departments or other job classes.

Programs Limited to Single Employee Class or Department

For example, the ED nursing leader may devise a system that rewards registered nurses within the ED for obtaining certain goals in patient satisfaction scores. If other departments hear about the program, they may be inclined to complain that registered nurses within their departments should be equally compensated for patient satisfaction scores. Ancillary departments such as radiology and the laboratory may ask to share in the enhanced compensation program because of the role they play in the satisfaction of ED patients.

Similarly, if only registered nurses are recognized financially for reaching these goals, it may disincentivize other staff within the ED. ED technicians and other support staff may perceive lack of fairness as they assist nurses reaching the goals ...

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