Moving Onward and Upward in a “Dead‐End” Job: Extrinsic Motivations and Rewards in Health Care Work

Abstract

What motivates people to enter health care occupations? What are the rewards of these jobs? What are the paths of mobility from low‐paid, low‐prestige, health care jobs to higher paid, more professional ones? This paper attends to these questions through interviews and ethnographic observations among West African immigrant nurses and disability support professionals in the US. I find that extrinsic motivations, (racial discrimination in other segments of the labor market), and the quest for extrinsic rewards, (wages, immigration status benefits), played a role in the decision‐making of West African immigrant health care workers. I show how West African immigrants were able to parlay low‐wage, entry level positions in the health care industry into more professional, highly paid, and secure ones. These workers also reaped material benefits, and developed intrinsic rewards (love/affection, job satisfaction), and the desire to help others after being immersed in their jobs. I posit an understanding of intrinsic and extrinsic rewards of care, as complex, layered, and intersecting. I prove that a mélange of motivations is in play, intrinsic and extrinsic rewards work in tandem, and one can enter health care for money and remain for money and for love.