Primum Movens

Recently, there was a comment on another blog regarding why people work.

Specifically, why I work.

I've always maintained that nursing isn't like other jobs-that money is not a prime motivator, that the intangibles are the most important things, that we work with our hearts and that in fact if you go in it for the money you won't succeed.

Nursing isn't retail. It's not accounting. It's not manufacturing.

It's working with human beings at the most frail, most humiliating, most vulnerable and occasionally most catastrophic times of their lives.

In the course of my career I've been assaulted by patients who weren't in control of themselves (thus not to blame, and that is not a negotiable conclusion: ie, don't even try to debate it with me). I've been assaulted by some who were. I've been harassed, I've been verbally abused, I've been discriminated against and been labeled with discriminatory epithets. I've been spit upon.


I've not always made much money. My first nursing job I made $9.00 an hour and thought I was all that and a bag of chips.

Even now, as a North Carolina nurse, I fall on the low end of the national averages. There are places in this country I'd make at least double what I make now, and jobs I'm qualified for that could pay me near triple.

To be sure, there are nursing jobs where you can make a great deal of money.

If you choose to go into some of the more elite specialties (CRNA, FNP) that are in high demand, you can find yourself the target of some lucrative deals indeed. But even for your ordinary, everyday trench nurse, there are high paying jobs.

We've all been bombarded with cold-calls from recruiters (we call em 'handlers') at staffing agencies, and have seen the outright salary bidding wars that can go on as agencies fight to get a nurse on board. We've seen the paradisical ads for travel nursing ("Winter on the ski slopes of Denver, summer on the beaches of Hawaii!) that promise everything up to (and sometimes including) a maid to clean the agency-paid condo you'll live in for the duration of your contract. We've had the sun, moon and stars promised to us by bright, eager HR people who hover possessively over you like turkey buzzards.


This week I've begun a new job, at a very large, state-owned facility for the developmentally disabled. This is a very particular kind of field, and one that's close to me, because it's an area I worked in prior even to nursing school. I enjoy the population, even though it can be (and was, for me) dangerous; it can also be a load of fun, and touch you in ways you never imagined.

Now, it's easy to point out that this is not a field everyone would choose to work in, and actually, many people who come into it find they can't do it. It's just not for everyone. Some people find it depressing, although I've never felt that way. Some people let the fear get the best of them, and some people just can't handle it.

So with this 'motivation' comment still in the back of my mind, today at work I decided I'd do a bit of impromptu research.



I explained in brief the backstory of the comment, and asked my coworkers (all RNs in this case) how they felt about it.

It sparked some immediate and animated discussion. A couple of things came to a quick consensus: every nurse present (including myself) was able to cite at least one or two lucrative, high-paying jobs they'd either refused or left for lower paying jobs in different areas of nursing. Two of the nurses there had actually left federal positions. I should also mention that I personally refused the same federal position. And everyone knows that federal jobs are some of the most lucrative, stable, and hard-to-get jobs out there.

So why on earth would someone leave a position like that, with unbeatable benefits, top-notch salary grades, and paid time off for holidays that most people never even heard of?

Everyone agreed that money was the least important factor in deciding whether to take, and keep, a job.

So what is it we're working for? What is it that motivates us, as nurses, to take a particular job?

The great majority of opinions cited intangibles. To put them into sentences that would make sense, these nurses said what was important to them in choosing and staying with a job was the opportunity to make a difference, being able to provide good care (this is a complicated thought that takes in the physical environment, the intangible environment and having access to everything you need to give care to patients), and most of all you hear that nurses, even the generalists like myself, have a soft spot for particular groups of patients and want to work with them, even if it means turning down a considerably higher-paying job. Some nurses love oncology. Some love surgery, or the OR. A very priceless group of nurses love the delicate and amazingly difficult area of hospice nursing. Thank God that there are people who love L&D, because you could not pay me enough money to go do that. Personally, I've always loved detox (although I hate psych) and, strangely enough, infectious disease. We all have things we love to do.

I have said a thousand times that nursing is unlike any other industry. People who don't do what we do can't understand why we do it. Perhaps some patients and families can sometimes get a glimpse of the reality of it, and maybe get a bit of a better understanding. But the vast majority of people seem to think that nursing is on a par with flipping burgers, working in a bank, or rotating tires. The truth is far different, and it cannot in any way, shape or form be compared with any mundane job in either object or motivation.

We work with our hearts, and if your heart's not in it, you can't ever be a good nurse. If you go into nursing because you think you will make a lot of money, chances are you won't even graduate, because your instructors are going to see that motivation in the way you give care, and they'll put a stop to you. The desire to make money cannot ever trump the desire to take care of people, to alleviate suffering, and to help your patients in any way you can. If it does, the care you give will be rubbish, mechanical, a sham. It shows, just in the same way that you can't fear working with people that have serious infectious, contagious diseases. The minute you let that fear get uppermost in your mind, the quality of the care you give turns to garbage.

I'm not sure if people know about 'pinning' and the pinning ceremonies nurses go through at graduation. Nursing is steeped in tradition-despite the fact that you may never see a nurse working in a cap (which, if you're in the know, is a way to identify a nurse's school-they are all different, and all registered, and you can't wear any style cap except your school's cap unless your school has never designated one, and then you may only wear a plain white one without ribbons or coloured trim) anymore, we all get them when we graduate, and we get our school pin, which gets pinned on you in a solemn ceremony. The focal point of the pinning ceremony (which, incidentally, often happens, at least around here, in a church) is when all of the new graduates take the Nightingale Pledge. This is, of course, named after Florence Nightingale, the most famous nurse of all, and runs thus:

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

And that's what our promise is, and that's where our motivation lies. And that's what makes nurses different. We don't think like you do, and what's important to you is not necessarily important to us. We take care of people. We want to do it right, and we want to do it well. And we choose the job that will let us do that in the best possible way. That's what motivates us.