Badly Paid Nurse a Good Nurse

ZASHAGALKA, RN · Oct 1, 2006

This issue was previously discussed in-depth:

https://allnurses.com/forums/f195/does-better-pay-better-care-170851.html

The author has a very valid point. RATHER than indict the concept as it applies to nursing, we SHOULD by actively changing the dynamics of nursing so that it doesn't apply.

Besides, the author left one key equation out of his formulation, and THAT is how the real working conditions of nurses has undermined the 'vocational' concept of nursing. I discussed that in detail in the above thread.

~faith,

Timothy.

ZASHAGALKA, RN · Oct 1, 2006

What I said in the above thread:

I read the article and pondered about it for awhile. And, I think this economist is right on the money.

Let me explain.

First he is referring to what he calls 'vocational' jobs, and he describes nursing as such a job. I think he is right, by his definition. His definition is a job where a worker 'invokes' a self-interest in seeking said employ, for example, being 'called' to the job. Examples would be teaching, preaching, and yes, nursing.

The economist describes a 'reservation' wage, the wage at which a job becomes too unattractive to do, at any less a wage. This is the point where too many people have 'reservations' about doing the job at any less a wage.

The economist argues, I believe credibly, that a 'reservation' wage can be set LOWER then an attracting wage when people are willing to do the job for motivations besides mere pay. By setting the wage at a 'reservation' wage that DOES attract candidates motivated by a 'calling' but would not attract candidates based on the actual wage, you end up recruiting ONLY those candidates with an inherent self-motivation to do the job, and do it well.

At the point you set the wage high enough the the 'reservation wage' would include those just interested in the salary, you attract candidates that may not have some inner self motivation to do the job well for reasons of 'calling'. These candidates might be more interested in just doing the job only as well enough as necessary to get paid.

The managerial concept involved here is known as 'organizational citizenship behavior (OCB)'. In any organizational environment, you have a diverse group of people, that can range from 'good soldier syndrome' - employees that go above and beyond without any extra motivation to do so, all the way down to 'slacker syndrome', people that do JUST ENOUGH to maintain their citizen status within the organizational structure, and nothing more.

By setting a 'reservation wage' below neutral recruiting value, but higher then a 'vocational (calling) reservation wage', you attract only the candidates that are interested for reasons that INCLUDE it being a calling. And THESE types of employees tend far more towards 'good soldier' types then they do 'slacker' types.

And this indeed is a formula that worked in the past. Nursing wages have always, historically, been lower then the actual neutral 'reservation wage'.

But, the key point in the formula is 'all things being equal'. Another point in the article, given a value for purposes of his statistical analysis, is the level of satisfaction that a 'calling' is ACTUALLY being satisfied by the work being done.

And here, TPTB, screwed with the formula. Beginning in the '80s, TPTB began to seriously change nursing into a big business. The focus on patient-centered care was turned to the focus of cost-centered care. As a result, many nurses were being deprived of the real 'connect' time with patients that led to satisfactory meeting the 'calling' they sought.

At the point nurses lost the simple time to interact meaningfully with patients, they also began to lose the 'calling' value to their jobs. At that point the 'vocational reservation wage' was simply no longer enough to meet their needs. And so, nurses 'burned out' and simply left the profession.

And THIS required hospitals to eventually raise the 'reservation wage' to continue to attract candidates into the field. So much so, that our schools are brimming over with potential candidates.

So today, as a direct result of administration short sightedness, many of the nurses that were working for a 'vocational reservation wage' simply left the field. Or, as WE say, there isn't a shortage of nurses, but a shortage of nurses willing to work under these conditions at these prices. The 'vocational' part of the job that allowed for a 'vocational reservation wage' was no longer meeting the 'calling' aspect of nursing enough to maintain that wage.

And so, today, our wages much more closely resemble a 'neutral reservation wage'. We see that in our schools, where many are indeed going into nurses today for the job security and salary.

We also see the throwback to nursing as a vocation in the threads where students complain that it isn't fair that they have to wait on a list when they are 'called' to nursing while others are just 'in it for the money'.

But, the DIFFERENCE between a profession and a vocation is that a profession sells its skills and value, and NOT it's motivated self interest to participate.

So, by referring to nursing as a 'calling' we are INDEED holding ourselves back. In more ways then one. Because the new dynamics on the units are such that the needs of nursing as 'calling' cannot be satisfactorily met, I argue that it is, in fact, nurses in it for the 'calling' that burn out faster then those with pure financial motivation. Those with a pure financial motivation can at least directly weigh their 'reservation wage' against the work being required of them.

And the result of this is that the salaries for nurses must go up. They must go up because it is TPTB that rooted out the ability to meet the needs of nurses 'called' by denying them the opportunities to answer that call on our busy units.

But we should grasp hold of this. Because inadvertently, TPTB have given nursing the rationale to be a profession and not merely a vocation.

We should be selling our extensive training, skills, and abilities and the unique combination of each within us that demands a 'reservation wage' set at a professional level. And that means, leaving our 'calling' out of the negotiation process.

Nursing cannot be about the NEED to 'care' if we want the salaries of high tech, high skilled bedside monitors and interventioners. THAT PROFESSIONAL view of nursing is what we must front, not the 'angels' of our nature.

To the extent that being 'called' to nursing can be factored into the process, our salaries will reflect this as a part of the total compensaton package, leading to a lower 'reservation wage' more vocational in nature then professional.

Or, to counter my former HR manager I referenced in my earlier post, "Why WOULD you think nurses AREN'T 'in it for the money'?"

~faith,

Timothy.

CHATSDALE · Oct 1, 2006

1. nurses like everyone else want the 'good things' in life for their families

and for themselves...maybe riding in a red convertible makes you smile

inside and say "i work hard and i deserve this"

2. nurses who are underpaid will try and even the gap with staying over,

coming in on days off until they are so stressed out that they cannot

function properly, mistakes are made...

3. this type of education is expensive and student loans have to be

repaid and you have to save so that your children don't have to sink

in the debt that you are trying to emerge from

no a nurse is as capable as their education, people skills, and dedication will allow them...giving a incompetent nurse more pay won't improve them but it may keep those in the field and at bedside longer and with more job satisfaction which is something we are entitled to

DusktilDawn · Oct 2, 2006

It's unfortunate that when it comes to nursing, we are made to feel ASHAMED when it comes to wages. In fact we are made to feel ashamed when it comes to basic needs and rights that other workers enjoy in this country.

Good nurses are not in it for the money

Good nurses don't take breaks/lunches

Good nurses never call in sick

Good nurses always put the job ahead of their own personal needs/lives

Sorry, but I'm fed-up with the guilt-trips constantly being fed to the nursing profession, especially when it comes to wages and work place issues. We as professionals need to stop feeding into this. Think about it, what is a good nurse worth to you as a patient? The word priceless should come to mind.

Interesting how Mr. Heyes can't be bothered to examine why nurses are leaving the profession and how to retain them. I think it's time people like him leave the dark-ages and come into the present.

casualjim · Oct 2, 2006

I'm saying this with the caveat that I'm "only a student" but I have finished a pretty succesful 21 career elsewhere. This isnt my first trip to the rodeo. In all my life I've never heard so much grief about a group of people getting paid to do a job as I have about nursing. Now you do hear a ton of griping about politicians getting paid but I discount that as I dont see politics as honest employment. Nursing however is a profession. Professionals get paid. Getting paid is part of the definition of professional. I'm not looking to be the next Donald Trump, but I dont see anything wrong with getting paid well. Does anyone go into a profession with the mindset of, " gee I hope I can make a measly subsistance wage, I love living off Beanee Weanee and Top Ramen."

aloha

Jim

HARRN2b · Oct 2, 2006

"We got to talking about this at my part time job today (that btw pays for texts for school). The women in question said nurses should not be concerned with money and that it should be a calling. Yep, I sure want to spend 30k on education to earn 10.00 an hour for a calling. NOT! For me, it is not all about money as I formerly had a successful career. That said, I will see to it that I make a living wage and not let some miserly administrator dictate to me that I need to be poor. I have no ties to anywhere in this country, That said, I can vote with my feet.

nurse4theplanet, RN · Oct 2, 2006

I think poorly paid economists are the better economists!

How do you like that Mr. Heyes???

Just because one finds satisfaction in their job (the vocational advantage mentioned) does NOT justify a poor compensation

When will people realize that it takes more than a strong interest and a need to help others to be a nurse...like, oh I don't know, SCIENTIFIC KNOWLEDGE??? Critical Thinking??? Understanding how to meet the emotional/psychosocial/physical/spiritual needs of the client SIMULTANEOUSLY while adhering to strict laws/standards/codes of ethics/hospital policies and the threat of a MALPRACTICE/NEGLIGENCE suit each time you turn around? Did I mention 12 hour shifts, heavy overtime, high nurse patient ratios, and understaffing???

Walk a mile in our shoes Mr. Heyes....

tridil2000, MSN, RN · Oct 2, 2006

I think poorly paid economists are the better economists!
How do you like that Mr. Heyes???
Just because one finds satisfaction in their job (the vocational advantage mentioned) does NOT justify a poor compensation
When will people realize that it takes more than a strong interest and a need to help others to be a nurse...like, oh I don't know, SCIENTIFIC KNOWLEDGE??? Critical Thinking??? Understanding how to meet the emotional/psychosocial/physical/spiritual needs of the client SIMULTANEOUSLY while adhering to strict laws/standards/codes of ethics/hospital policies and the threat of a MALPRACTICE/NEGLIGENCE suit each time you turn around? Did I mention 12 hour shifts, heavy overtime, high nurse patient ratios, and understaffing???
Walk a mile in our shoes Mr. Heyes....

apparently this guy missed his economics 101 class.

you get what you pay for.

casualjim · Oct 2, 2006

"... I will see to it that I make a living wage and not let some miserly administrator dictate to me that I need to be poor. .

You make a good point, why shouldnt it be a calling up and down the food chain? Hospitals and health care "systems" just giving services away because we're all just "called" to do it. If only I could get my mortgage company to be "called" to pay off the 1953 house I'm living in. Maybe get Domino's to be "called" to slide me a large peperoni pizza on the house to boot.

aloha

Jim

PeachPie · Oct 2, 2006

Pfft most people smart enough to become nurses aren't dumb enough to be doormats and masochists!

Justhere, BSN, RN · Oct 2, 2006

One of my instructors once said if this was a male dominated profession it would be paid higher. I do the nursing because I have always wanted to take care of people, especially kids. But it does kind of tick me off at times thinking about my husband who never went to college makes $20,000 dollars more than me and I've been to votech and college once for my LPN then once for my RN.

piper_for_hire · Oct 2, 2006

I always find it upsetting when these conversations turn towards how nurses "deserve" more pay. This is music to the ears of the people who don't pay us what we deserve. The fact of the matter is that deserving compensation has little to do with actual compensation in our free market system. Of course, I'm stating the obvious here. What is confounding is why nurses don't take advantage of the free market system. Unions take a stab at this, but our wages are still crap. The nurses that claim it's their calling and they'd do it for free are stabbing us in the back. I think it's great that you would do it for free, but some of us have bills too.

The argument that paying us more would produce bad nurses is silly at best. The fact of the matter is that paying us more would create a higher demand and allow hospitals to be more selective in who they recruit and who they retain. Double our compensation and you will get yourself some excellent nurses. Look at the bottom line. Who really cares if your nurse is motivated by cash or by calling? Having a calling doesn't guarentee good nursing. Having a desire for a high standard of living doesn't guarentee it either. However, having high performance standards is the closest thing to a guarantee you'll ever get.