What gets you up in the morning?
An old myth about nursing is that is a vocation, a calling based on the desire to help and care for each other. Currently nurses are being criticised for being too educated to care, that they have lost their compassion. I don’t think these things are true. Nurses come to work for a variety of reasons, chief among them of course is paid employment. However, pay itself is not the issue either. Managers and governments need to address more fundamental issues if they want nurses in the NHS to fulfil their mission to provide high quality complex care.
The first thing to do is to dump old ways of thinking regarding motivation. The theory that if you reward good performance then you will get more if it and the converse that punishment of poor performance reduces it, is flawed. Daniel Pink (2009) reviewed the science and based on a good deal of research in both private sector and public sector organisations, criticises the carrot and stick approach.
First the pay issue, the carrot and stick method works when the task is mechanical in nature needing little or no thought. Then rewards for good performance works. Tasks requiring more than rudimentary cognition are different. The globally replicated research indicates that staff who were extremely well remunerated actually performed poorly which might explain why the global finance sector crashed. High pay does not lead to high performance. Pay has to be set, though, to remove it from the table as an issue, so there is a baseline to be achieved where staff no longer worry about their salary. Beyond that level there are there are three other factors at work: Autonomy, Mastery and Purpose.
We need Autonomy to perform well and to be creative. Second we like Mastery. It appears that we like to get better at things, we like to practice to master our skills and finally we need Purpose (or vision) over and above the profit motive. If profit (or cost cutting) is the only goal things go pear shaped. Successful organisations want to make a difference and they develop a transcendental purpose.
The lesson for the NHS is clear. Calls for more nursing leadership to address poor care will fail unless nurses are given or allowed to develop these three things: Autonomy, Mastery and Purpose…that is what will get the nurse leaders of tomorrow really making a difference. Are our organisations up to the task of setting staff free or will they not take the risk and do more of the same? Bureaucracy, managerialism and petty fogging quality processes will kill this initiative. Identify your key members of staff and then give them autonomy to be creative and to master their skills and knowledge, ‘sell’ to them a higher purpose, let them develop their own purpose, and if you don’t know what that is you have work to do. Hands up those of you who can clearly articulate that these three things are your daily experience?
Pink, D. Drive. (2009) The surprising Truth about what motivates us. Canongate. Edinburgh.