Moving beyond generational narratives of healthcare workorce motivation to universal human needs

Workforce motivation is a persistent concern for healthcare systems facing workforce shortages, retention difficulties and rising service demand. Generational differences are often used to explain variation in staff motivation, but the extent to which these differences reflect genuine motivational variation, rather than changing organisational conditions, remains contested. This article examines whether workforce motivation in healthcare is best explained by generational differences or by universal psychological needs shaped by organisational context and leadership. A narrative synthesis was undertaken to develop a conceptual framework for workforce motivation in healthcare. The authors suggest that generational explanations for motivation are conceptually weak and empirically limited, with self-determination theory providing a more robust account, indicating that autonomy, competence and relatedness function as universal psychological needs across groups. Differences in staff experience are thus better understood as arising from context, including workload, leadership, psychological safety and the alignment between professional values and organisational systems. Values-based leadership emerges as a key mechanism for enabling engagement, while persistent misalignment may contribute to moral distress, moral injury and poorer organisational performance.