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  1. Falter, Elizabeth (Betty) MS, RN, NEA-BC

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Drive: The Surprising Truth About What Motivates Us. Daniel Pink, 2009, New York, NY: Riverhead Books. Softcover, 260 pages, available at http://Amazon.com for less than $10.


How many of us have learned the proverbial lesson that throwing money after a problem does not work? In fact, it can be counterproductive. Given our attempt to bend the cost curve in health care, alternative models of motivation are indeed needed. The author goes beyond our individual lessons in life and explains why. Using evidence-based research in psychology supported by management gurus, the author introduces us to his goal to repair the gap between what business does and what science knows.


Following the evolution of human drives, the author takes us from survival (50 000 years ago) through reward and punishment (Industrial age), both of which are extrinsic rewards. He argues what truly motivates us today are the intrinsic rewards of autonomy, mastery, and purpose. Our natural default is to be self-directed. If engaged, we seek to become better at what we do. As humans we seek purpose.


To better understand these motivational drives, the author refers us to the concept of type I and type X behaviors. Type I behaviors find satisfaction in the work itself, whereas type X seeks extrinsic rewards. A full chapter is devoted to a discussion of these 2 kinds of rewards. The author references the classic management theory of X and Y, where work is considered as natural as play or alternatively people have to be made to work or at least rewarded to do so.


At this point, the reader, like me, has waited patiently for the ultimate question-what about the money, compensation, benefits? These extrinsic rewards do not disappear. The author suggests we should just remove them as the center of attention. Do your research, ask to be paid what others are paid for these jobs, but then take this issue off the table, so people can focus on the work and the rewards from this work.


Fortunately, the author has created very practical tools at the end of the book to help organizations tap into this thinking. One of the important tools is a reading list many of us will recognize, including Peter Drucker, Peter Senge (Fifth Discipline), W. Edwards Deming, Jim Collins (Good to Great), and more. This book draws on the research and thinking of many past leaders, with a detailed reference list as one of the tools. There is even a tool dedicated to how to pay or compensate people.


You may have noticed in your career that the high achievers, your hardest workers, or your best performers may be paid well, but it is not the money that drives them to work. While nursing has just begun to catch up with other professions in terms of salaries, for years, most nurses were driven by the reward of the work itself. We need to be very careful not to remove that intrinsic reward that has served our profession well. A few years ago, one of our executive lunch speakers at the Arizona Healthcare Leadership Academy addressed this issue. He encouraged the new managers/leaders to join an initiative at their place of work. But he cautioned them not to ask, "How much more money are you going to pay me?" That person, he felt, would not make a good team member. Furthermore, he cautioned the group, if you are seeking to be in the executive suite, do not do it for the money. Yes, the job pays well, but the money will not be what gets you to put in the long hours.


In my interviews of several RN chief executive officers, not one mentioned money as a driver. When you hear about motivated staff nurses in Magnet and Magnet-like hospitals, you rarely hear about the money. None of this is new. We inherently know these concepts to be true. What this book does is pull it all together for us. Read the book. What I would do next is recommend this book to your organization's book club or put together a team of readers, drawing on human resources compensation experts, nurse recruiters, nurse governance councils, and senior leadership. The author provides in his toolkit a list of discussion questions. Even if you do not formally adopt these ideas as an institution, the concepts will be useful in your leadership role and in your own personal life.