The Most Taxing Job in the World? How Nurses Get and Stay Motivated

Those of us who have done work that involves taking care of others – of children, the elderly, and especially the sick – know that this type of work is both emotionally and physically draining. This has never been more true than over the past few years, with the COVID-19 pandemic putting unprecedented amounts of pressure on care workers across the world. Nurses, in particular, have been at the most intense frontlines of the pandemic. In addition to being exposed to a potentially deadly virus on a daily basis, nurses have also been forced to put their mental and emotional health at risk. According to one study, an estimated 34% of nurses experienced burnout – debilitating emotional exhaustion – during the first year of the COVID-19 outbreak. This record level of exhaustion also poses a severe threat to public health, as high nurse burnout rates are associated with threats to patient safety and survival.

            More recently, over 7,000 New York City nurses went on strike to protest poor workplace conditions and staff shortages at their hospitals. Cost-cutting and high burnout rates among nurses have created a vicious cycle at hospitals across the country, exacerbated by the COVID-19 pandemic, where poor working conditions have led to low retention, which in turn has led to even poorer working conditions and therefore even lower retention. The strike, whose organizers said the goal was to ensure patient safety, called for measures to make the job more manageable and attractive such as increasing pay for nurses and eliminating staff shortages. Ultimately, these measures can both recruit more nurses back into the profession (many of whom left during the height of the pandemic) and increase nurses’ mental well-being on the job.

            Given all of these challenges, it is difficult to understand how the nurses who work in hospitals have been able to stay motivated. A long-standing scholarly tradition in organizational behavior studies acknowledges two types of motivations that keep people committed to their job: intrinsic and extrinsic motivation. Whereas intrinsic motivation refers to the joy or satisfaction we may get from actually doing the work itself, extrinsic motivation refers to any perceived benefit or satisfaction we get out of the job that is not rooted in the actual tasks of the job. For example, as a doctoral candidate, my intrinsic motivation could be that I love conducting research (designing surveys, analyzing data, etc.) while my extrinsic motivation could be the satisfaction I will feel once I receive my PhD. Receiving the degree is external to the actual tasks I am completing on a daily basis, but it is a benefit that is conditional upon me doing the work.

            In past research on the topic, care workers such as nurses have been understood to be driven primarily by intrinsic motivation. Of course, the nursing profession can entail many different intrinsic motivators such as the joy of helping people, of saving lives, of meeting and talking to people, of feeling needed, or feeling a sense of gratitude from patients. However, as we have seen with recent retention issues and strikes, even powerful intrinsic motivation can be insufficient for nurses who have left or are considering leaving the profession. By pushing for higher wages, for example, unions and nurses around the country are now aiming to increase the extrinsic motivation for nurses in the hopes that more people will be attracted to and stay in nursing.

            In an article in Sociological Forum, Fumilayo Showers shifts the narrative of what motivates care workers by shedding new light on some important extrinsic motivators. Focusing specifically on West African immigrants who enter into care work, Fumilayo shows that the prevalence of racial discrimination in other sectors and the possibility for career mobility are two important extrinsic motivators for starting a career in care work. In other words, they see nursing as a viable career path because they are less likely to be racially discriminated against and less likely to be stuck in low-status work, as they can gain credentials and licenses to climb higher on the occupational latter. While the care workers interviewed for the study ultimately gained intrinsic rewards from the profession, what first brought them to care work was these extrinsic motivators. This is an important finding, because it shows that one possible solution to the staffing shortages experienced at hospitals across the country could be to further increase opportunities for upward mobility in care-work. If ultimately reaching a stable, well-paying, and reasonably demanding job becomes easier for those starting out at the bottom of the pipeline, there will be more extrinsic motivation for people to start entry-level care work – enabling us to eventually fill much-needed positions at hospitals.