Building on Self-Determination Theory to Unravel the Motivational Drivers of Nurses and Rehabilitation Therapists in a Moroccan University Hospital: A Qualitative Study

Abstract

Background: Nurses’ motivation is essential for ensuring the quality of care and workforce retention. Understanding the underlying psychological mechanisms is essential, particularly through Self-Determination Theory (SDT). This approach clarifies how work environments influence work engagement and performance. Existing research has explored SDT in various contexts. However, little is known about how contextual and organizational factors specifically impact nurses’ motivation in low- and middle-income countries such as Morocco. This study contributes to addressing this gap. Objectives: This study explores how organizational factors within a Moroccan university hospital influence the BPNs’ satisfaction in a Moroccan teaching university hospital. Methods: An exploratory qualitative case study was used. Purposive sampling was used to select 26 participants, including nurse managers (n = 7), rehabilitation therapists (n = 5), pharmacy technicians (n = 4), nurses at the Hematology Department (n = 4), nurses at the Emergency Department (n = 4), and nurses in the outpatient consultation unit of the Otorhinolaryngology Department (n = 2). Data collection was conducted from March to June 2023, following ethical approval. Data analysis followed Yin’s five-step process, incorporating deductive and inductive coding, within- and cross-case thematic analysis, and iterative explanation-building. Results: Identified motivation emerged as the most frequently reported type, although BPNs’ satisfaction varied. Rehabilitation therapists consistently reported high levels of autonomy, competence, and relatedness, which were attributed to transformational leadership, task specialization, and a supportive organizational culture. In contrast, nurses experienced role ambiguity, transactional leadership, excessive workloads, and limited autonomy in decision-making, all of which contributed to unmet BPNs. Performance evaluations and financial incentives were widely perceived as unjust. Conclusions: This study shows that in LMIC hospital settings, nurses’ motivation depends on organizational support for their BPNs, especially in resource-constrained environments. The significant disparities between professions within hospitals indicate that supportive environments with autonomy-supportive leadership, clear roles, fair evaluation, and adequate staffing are both achievable and essential for motivating and retaining nurses.