What Motivated Workers in the Face of a Pandemic? Sometimes it's easy to figure out what's going to motivate workers. But at other times it's nearly impossible to know what would make someone want to persevere in a particular job. During the COVID-19 pandemic, health care workers across the globe stepped up and sacrificed themselves-in ways that the rest of us may never fully grasp-in order to take care of humanity. They exposed themselves and their families to the virus, they worked without proper personal protective equipment (PPE), and they kept at it during gruelingly long shifts, day after day. Reports estimated that health care workers infection rates were somewhere between 10% and 20% of the total cases. On the surface, it seemed there were no plausible explanations for why these workers continued to show up to their jobs throughout the crisis. JUST HOW BAD WAS IT? Health care jobs are some of the most stressful jobs in the world. Studies of occupational stress and burnout are often conducted using health care workers because as a professional group they are exposed to extreme stressors on a consistent basis in their jobs. In fact, pre-COVID-19, 63% of hospital nurses were already experiencing significant job burnout. During the pandemic, things became much worse. Some ER nurses, who typically cared for 4 to 5 patients per shift, were suddenly responsible for 25+ patients, with more than one-third on ventilators requiring highly specialized care and attention. 205 Health care workers realized quickly that they were at high risk of exposure to the virus. One nurse reported that managers gave him and his co-workers two N95 masks each week. Intended to be thrown away after each exposure to a dangerous pathogen, the masks became reusable, and nurses stored them in bags between shifts. "There's no way you're not getting it if you are working in the emergency room with the bare minimum protection," he said. 206 Another nurse reported high levels of anxiety and worry surrounding health care workers jobs. "I would say that there is 100 percent tension in the air, nurses and health care providers are scared, "she said, adding, "They're scared to work and are mentally and physically being torn apart by this."20 INCENTIVES As health care facilities became overcrowded and worker shortages became apparent, states began announcing incentives to attract more health care workers. For example, in Arkansas, Governor Asa Hutchinson announced that nurses would receive a $1,000 monthly bonus payment during the pandemic, and that number would double to $2,000 if they worked in a facility with a confirmed case of COVID-19.205 New York hospitals offered nurses upwards of $4,000 per week. Said one nurse who left her job in Detroit for a higher paying position in New York City. "When you're overworked and understaffed, you're going to go somewhere where they're going to be more appreciative of you," adding, "I felt like I was going to make a difference in New York.*209 EXHAUSTION AND ILLNESS No amount of money could have made up for the physical and mental toll that the pandemic took on health care workers. One ICU nurse experienced repeated bouts of respiratory symptoms, with COVID- 19 testing coming up negative each time. She shared, "I realize that the mental anxiety that has been running through my veins for weeks on end since we've been talking about this is physically making me sick. *210Another nurse recalled passing out in her driveway after a lrhour hospital shift in a COVIDel9 unit "I just closed my eyes for what I thought would be a minute and I woke up three hours later. I guess I wasJust that tired.-= she said: Due to the extreme precautions that health care facilities had to take in order to protect the population. most people who became gravely ill due to the virus had to face it alone. without the support of family or friends. For these people. physicraris and nurses were their only connection. and for many. the last people they ever saw. Said one worker. "It's heartbreaking as a nuise to know that you are that person's everything and. sometimes. in their last moments . . . the weight oftrying to till the shoes ofthe people who can't be there is really heaty. PRESSIXG ON Somehow. through all of this adveisity. thousands ofhealth care workers continued to show up for work ready to do everything they could to help the sick. Cardiac nurse Jeff Morawski said of his time in ICU during the pandemic. "You don't know what you're walking into. and you don't know if you'll be able to walk away without being sick. yourself= adding. "You walk in every day because you have a job to do.' For many. shifts became focused on ways to keep themselves motivated. keep patients' spirits up. and care for one another. For example. nurses and phySicians kept whiteboard tallies of CO\" )-19 patients who had successfully come off of ventilators and recovered as a way to remind themselves that there was hope amid all the despair Page 559they were Witnessing Critical care physician and medical director of care experience for the Henry Ford Health System Dr. Rana Awdish said that she started rituals in her clinic to check in on workers each day. She explained. "Not rounds on the patients. but rounds on the nurses and physiCians. andJust go to them and. you know. ask the open-ended questions of what concerns you most today. you know\" Do you have what you need to take care ofyourselt" \"hat are you worried about? Who's having the hardest time on your team'.' How can we support _you'.""::'1 Another worker spent her time doing what she could to cheer up patients by drawing crowns. silly faces. and even Tiger King characters on her clear curved face shield before she entered their rooms (the shield had to be wiped clean with disinfectant after each visit. and each time. she drew something else for the next patient}. Crowds of people cheered on workers in Cities like New York City each night. showing support With songs and applause. One nurse said that she had never felt more appreCiated or supported than she ' 15 THE LONG-TERM EFFECTS did during the pandemic. In spite of the solidarity. positivity. and perseverance of health care workers amid the pandemic. real concerns eXist about the long-term impacts that the crisis will have on their health. gaid one expert. "A lot ofpeople in the health care field have been struggling with burnout for a long period of time;= adding. "preople don't have the ability to decompress or have that time to ground themselves. and care for themselves. go to the bathroom and eat good meals. see their familiesespecially if they're already dealing with that level ofburnoutmy concein is that that burnout is going to become more severe." Indeed. Dr. Awdish predicts that a surge ofpostrtraurriatic stress disorder is likely to ripple through the health care workforce as the chaos begins to calm down and health care workers have time to process the ethical dilemmas and heartbreaking Situations they dealt with in their roles