An often-repeated anecdote about how Florence Nightingale decided nursing was to be her life’s work is an incident that occurred in 1837. In her diary entry on February 7 of that year, she wrote “… God spoke to me and called me to his service.” The biographer Mark Bostridge remarked that this experience was likely an inward revelation of Nightingale’s intense resolve to become a nurse, rather than a hallucinatory episode. A non-exhaustive literature search on studies looking into motivations to choose nursing as a career in the past 20 years reveals a consistent finding—a strong and genuine desire to help others remains the predominant motive for choosing nursing. Divine intervention or a conversation with God is never invoked as an impetus in the career decisions of today’s nurses.
When President Obama rallied the legislature to reform the healthcare system, he sought the advice of nurses. In his remarks on July 15, 2009, he said, “I know how important nurses are, and the nation does too. Nurses aren’t in healthcare to get rich.” What if Obama is wrong?
Is money that important?
For some, yes. And this is true for any profession. In the history of nursing, the above average wages offered to successful nursing applicants to work during the Crimean war under Nightingale’s supervision was a powerful incentive. The COVID-19 pandemic, 10 years after Obama’s comment about why nurses choose nursing, made salary a decisive factor in choosing travel nursing. The 2022 Nurse Salary Research shows that higher pay was the number one reason for becoming a travel nurse. Social media platforms are abuzz with posts pitting travel nurses against permanent staff. However, I doubt if a lasting solution to the chronic nursing shortage will percolate from foaming online discussions.
To attract and retain nurses, and to keep them from traveling, the experts suggest higher salaries, flexible work schedules, sign-on bonuses and relocation packages, loan forgiveness, tuition assistance, incentives for pursuing certifications and other career development opportunities, and enhanced benefits (such as better retirement plans and childcare discounts). All of these remedies have a monetary value or a dollar equivalent. Mind you, all of the above have been tried before with limited success. We can all agree that appreciation of nursing’s worth can’t be solely expressed in the sums of the nurse’s W2 form.
In my opinion, the success of nursing as the most flexible role in healthcare contributes to the never-ending nursing shortage. New grads typically start at the bedside and, soon enough, find another role with better conditions and less stress, or they transition to an advanced practice role. A new generation of nurses are joining the workforce with disparate initial aims and final life goals. Perhaps it would be un-nursing to declare that one joins the profession for the money. But, then again, maybe not.
I wonder if the image of nursing as the most ethical of professions is dimmed (at least among nursing peers) by the idea that a subsegment of nurses are paid significantly higher for the same workload? One thing that’s for sure: Cashing in a higher salary isn’t the same as living an enriched life.
In December 2022, the New York Times ran the article The I.C.U. Nurse: A Symbol of Endurance. The article is an ode to intensive care unit nurses, and reminds us that nursing is intimate, transformative work. There is a shortage in nursing staff, but the greater tragedy would be a shortage in caring. Nurses described in the article spoke about connectedness and allowing oneself to be transformed by the experience of patient care. Like them, I still vividly recall by name several patients I took care of in the early 1990s, not because they were sicker or had novel diagnoses, but because they enriched my ethical comportment, though I didn’t know it then.
The book The Good Life by Bob Waldinger, professor of psychiatry at Harvard Medical School, explained that brief warm interactions with weak social ties (I imagine the patients and their family) enhances our feeling of well-being. Feeling connected with patients may give the staff a happiness and well-being boost, and by extension reduce burnout. Some hospitals have a policy for nurses to sit with their patients for a chat at least once a shift. That makes sense.
The gift of nursing: No returns, no exchanges?
Unlike Florence Nightingale, I didn’t hear an ecclesiastical summons to get into nursing. I merely wanted an education. I can’t deny that I came to work in the United States to improve my family’s economic prospects, but it’s my nursing work that continues to enrich my lived experiences. Perhaps it sounds sentimental, but, like my patients, at the end of my life, I want to be remembered for who I was, not for how much money I earned or have cost healthcare.
For years to come, the nursing profession will continue its soul-searching in an attempt to figure out what to do with the endemic trilogy of nursing shortage, the aging population, and a broken healthcare system. The decision to stay at or to leave the bedside is largely a personal one. Nurses will continue to leave—with or without pandemics. May the tired phrase “once a nurse, always a nurse,” be true, and that wherever nurses are, they may go above and beyond for their patients. It would be nice if their employers did the same for them. Now.
Fidelindo Lim is a Clinical Associate Professor at New York University Meyers College of Nursing
Bostridge M. Florence Nightingale: The Making of an Icon. New York, NY: Farrar, Straus and Giroux; 2008
Nurse.com. 2022 Nurse Salary Research Report. nurse.com/blog/wp-content/uploads/2022/05/2022-Nurse-Salary-Research-Report-from-Nurse.com_.pdf
Obama White House. Nurses join President Barack Obama on health care reform. July 15, 2009. obamawhitehouse.archives.gov/video/Nurses-Join-President-Obama-on-Health-Care-Reform?page=4#transcript
Sandstrom G M, Dunn EW. Social interactions and well-being: The surprising power of weak ties. Pers Soc Psychol Bull. 2014;40(7):910-22. doi:10.1177/0146167214529799.