Point of care: What motivates you as a nurse?

By Michael C. LaFerney | 01/11/2018

Both of these nurses do their jobs, but for different reasons.

Photo of nurse
Feeling burned out? Going through the motions? Get back on track by reflecting on why you became a nurse in the first place. 

Michael C. LaFerneyDawn and Steve are both nurses on Unit A. Dawn is working on her BSN to advance in the profession. She always exceeds her state’s minimum requirement of continuing education units (CEUs) and comes in on days off whenever there are in-house learning opportunities. She loves to learn new things and prides herself on being a lifelong learner.

Steve is regarded as a proficient nurse but usually just meets the CEU requirement and deadline. He covets his time off and rarely looks at nursing-related articles. He views nursing as a job with a good salary and benefits that allows him to pursue other interests when not working.

When Dawn is passing out meds and comes upon a medication she is not familiar with, she looks it up online to learn what it is for, its side effects, and the usual dosage. She views being able to educate patients about their treatment as one of her goals.

Steve passes out meds but doesn’t look up unfamiliar medications because he views his role as technical in nature—delivering the right medication to the right patient at the right time. “There are so many medications out there and new ones coming all the time—a nurse can't possibly know them all!” Steve says. “Plus, if patients ask about their medication, I can always call the pharmacy and give them the information later.”

If the unit is busy, Dawn is willing to switch her lunchtime to accommodate an unexpected event. She does take her lunch break as required because she knows it will help refresh her for the remaining events of her shift. Steve always takes his break at 11:30, no matter what. “The work isn’t going anywhere,” he says. “It'll still be there when I get back.”

Dawn takes care of her assigned patients but assists other nurses if they ask or need her. Steve does a good job with his assigned patients but refers other patients who ask for assistance to their own nurse or CNA. Both Dawn and Steve do their jobs, but they have different motivations.

Motivation is a need or drive that energizes a person toward accomplishing a goal. Motivation can be intrinsic or extrinsic. Intrinsic motivation is self-directed—you do something because you enjoy it and find it interesting. Extrinsic motivation is done for external reward or to avoid negative consequences.

Let’s look at Dawn. She is working on a BSN that will result in higher pay and advancement. This is extrinsic in that the reward is more pay and status. But she also loves learning new things and wants to be the best nurse she can be as judged by herself and not others. However, she does want the respect of her peers and patients because she truly cares about them, shown by her willingness to help other nurses’ patients and deferring her lunch when needed. In other words, Dawn exhibits both extrinsic and intrinsic motivation.

Altruistic motivation occurs when you help someone with no expectation of reward. Dawn will, at times, without any expectation of reciprocity, help Steve with his patients’ dressing changes. If Steve helps another nurse, it is often with the caveat, “OK, but you’ll owe me.” Steve’s view of nursing is mostly extrinsic. It’s a job that consists of technical tasks to be completed in a certain period of time on an assigned number of people in exchange for a paycheck and benefits. Most of Steve’s goals are to benefit Steve, such as getting his lunch on time and limiting his workload to “his” patients.

Both Steve and Dawn do their jobs well enough to stay employed. Everyone is different with regard to experiences and motivations. It is hard to say if one’s motivation is right or wrong, so long as required tasks are performed. But I ask you, with whom would you rather work—Steve or Dawn? Which nurse would you prefer if you were a patient?

Nursing provides many extrinsic benefits, including a good salary, healthcare benefits, awards, and status. There is nothing wrong with pursuing them. We like and expect something of value—whether money or praise—for our work. But I’d bet the vast majority of nurses who are Sigma members have achieved what they have because they are intrinsically and altruistically motivated—because they love nursing, learning new things, and helping others. They experience satisfaction knowing they are doing what it takes to be the best nurse they can be as they and their colleagues pursue global nursing excellence. Me? My goal is to be the Michael Jordan of psychiatric nursing!

Yes, nurses become burned out and go through the motions at times. A good way to get back on track is to reflect on why you chose to become a nurse in the first place. Incentive theory suggests that engaging in activity that provides positive reinforcement is motivational. As a preceptor, look into the faces of newly graduated nurses who show pride in acquiring the knowledge you just shared with them. Their response lets you know you’ve met their intrinsic need to learn more as they pursue becoming the best nurses they can be, and it serves as positive reinforcement for you—extrinsic motivation—to keep on doing it.

Michael C. LaFerney, PhD, RN, PMHCNS-BC, is a psychiatric clinical nurse specialist at Arbour SeniorCare in Haverhill, Massachusetts, USA.

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