“How empty is theory in the presence of fact” Mark Twain
To get the gears spinning again, in preparation for classes which resume in a week or so, I read the following article; "Why a Well-Paid Nurse is a Better Nurse" by Julie Nelson and Nancy Folbre. It came to my attention through my online Medscape Nurses
subscription. (If you don't have one, I highly recommend it. Its free and worth the 2 minutes it takes to sign up.) I have found most articles to be timely, intellectual, and interesting. This article proved no different.
I did have to leave my AOL Dictionary window open while I read the article, as it was written as a "review" of sorts and involved several economic terms with which I was unfamiliar.
The article examines the theory (by economist Anthony Heyes) that a willingness to accept a lower wage, all else equal, distinguishes a good nurse, from the "wrongsort." In retort the authors pick apart this theory and expand upon their own theory which supports higher wages for nurses. Heyes argues raising nurses' pay would reduce the proportion of nurses who have a natural vocation for the field and result in a decrease in the quality of care provided by those nurses.
Within the article, the concept of Crowding In or Out is really what peaked my interest. Crowding Out or Intrinsic Motivations
is a concept that is best illustrated by the blood supply study conducted by Richard Titmuss
(1971). In it he proved that in some cases, paying people to do something they might otherwise do voluntarily can drive out their impulses to do the activity for their own pleasure, other's benefit, or other internally supplied reasons. The economist this article argues against (Heyes)asserted that paying nurses a higher wage would actually produce lower quality nurses uses the crowding out theory to support his position.
An economist who did further research on Titmuss's work, (Frey), found that the theory must be taken further in order to be fully realized. To truly understand the concept and how it would directly effect the subject of nursing wages, you need also to understand the importance of Crowding In. Frey actually found that external motivations like pay "crowd out intrinsic motivation if they are perceived to be controlling, and they crowd in intrinsic motivation if they are perceived to be acknowledging." So vocation can actually be dampened or extinguished or strengthened by an employers choice in how to compensate their nurses. If high pay is given in such a way that nurses feel respected and rewarded for their care and professionalism, feelings of vocation can be reinforced and expanded. In turn, creating a better nurse.
Heyes's "theory" is junk on so many levels I don't know where to start. Here is a quick list compiled after reading the article.
1. Even the strongest of vocation does not guarantee skill. Attracting nurses w/ only
high vocation is risky in that it may be a trade for skill levels. Nurses need both to be good ones.
2. Nurses who have both vocation and skill have a higher reservation wage (will not work for less than "x"). So not offering at least that wage, will drive them to other professions that are willing to exceed their reservation wage, even though nursing may have been their first choice.
It is extremely important that Heyes and his theory does not influence the opinions of the HR Directors working in healthcare. Nurses are people who bring a strong sense of vocation AND a huge skill set to the healthcare environment. If our hospitals need these people, we have to be willing to pay for them. There is a need to recognize the value of a worker who is skillfully trained AND has a strong vocation for the nursing profession. We may never see an end to the nursing shortage unless attitudes like those discussed above are changed.