Nurses motivated by external rewards are more likely to survive on the job

Care not the only quality. Nurse by Shutterstock

When we think of nurses, we generally think of someone with high social motivation and a strong desire to help people. The nurturing, altruistically motivated individual – probably female – plays strongly into our image of the ideal caretaker, someone who has an innate and maternal desire to look after others.

Pro-social motivation is often contrasted with extrinsic motivation – the motivation to perform based on job rewards such as wages, benefits, or the opportunity for promotion. Extrinsic motivations are seen to belong to the marketplace and viewed sceptically when it comes to care work. Some have even argued that a willingness to accept lower wages distinguishes a “good” nurse from the “wrong sort”, or the sort who is highly motivated by extrinsic rewards.

Individuals can also be motivated by intrinsic rewards, or an inherent enjoyment and interest in the work itself. Intrinsic motivation is often conflated with social motivation to do good when it comes to nursing because we equate care with “kindness” and fail to recognise the skills needed to be a competent nurse and caregiver. Consequently, we assume the enjoyment a nurse has in a job comes only from providing help to others, not from the actual job tasks themselves.

Does reason for motivation matter?

In most occupations, we care very little as to why someone is motivated to do their job; someone can choose a career in manufacturing or finance because they want to help others, because they enjoy the work itself, or because they simply want to make money. In nursing, however, we have strong cultural assumptions about what kind of motives a person should have – and, of course, what gender they should be.

But research we recently presented at the American Sociological Association conference suggests that nurses with very high pro-social motivation are more likely to report higher levels of burnout, or emotional exhaustion. These nurses report that they feel emotionally drained, or that they dread having to face another work day.

Why might being highly motivated to help others lead to burnout? Past research suggests that normal individuals choose to care for others from a base of self-respect, ability to take care of their own needs (rather than just the needs of others) and distance. In contrast, those who are selfless and try to “live through others” may confuse their own needs with those who are being cared for, which means they are more likely to lose boundaries that would have prevented burnout. In other words, you can probably care too much.

On the other hand, those who reported higher levels of both intrinsic and extrinsic motivation reported significantly lower levels of burnout, negative physical symptoms, and a lower intention to leave their jobs.

These findings indicate that workers who pursue a job in care for reasons other than – or in addition to – good social motivation, find the work to be less stressful, both emotionally and physically.

This has implications for how we think about what it means to be a “good” nurse and can help us to address questions such as whether we should we be concerned that higher wages for care workers will change the nature of their work or attract the “wrong” people to the job.

Fears about the motives of nurses may be related to the idea that marketisation automatically brings with it norms of self-interest and individualism that are incompatible with a family-based ideal of care. But our findings suggest that motives that expand beyond the stereotyped characterisation of care are protective for the health of workers and may benefit health organisations and patients in the long run.