By Paul M. Dohse, RN, CDP
Introduction
Abraham Maslow’s Hierarchy of Needs is a priority of care framework for healthcare. If you are pursuing a career in nursing, six priority frameworks are taught to structure best practice. They are Maslow’s Hierarchy; the ABC Framework of Airway, Breathing, and Circulation; Safety and Risk Reduction; Acute vs. Chronic / Unstable vs. Stable; Least Restrictive / Least Invasive; Survival Potential (Triage).
Maslow’s Hierarchy is usually listed first as the most basic and fundamental. In fact, the principles of Maslow’s hierarchy are seen almost everywhere in healthcare. And that is a good thing. Unfortunately, its primary focus is patient care only. This article focuses on selfcare as well, but not only that, we want to focus on Maslow’s application to wholistic care, or care for the whole person in patient care and selfcare.
The thesis of this article follows: understanding a full orbed application of Maslow’s hierarchy is key to surviving the most toxic work environment that exists today; healthcare in general, and nursing in particular.
Maslow’s Theory
According to a short video by The School of Life, a YouTube channel with nearly ten million subscribers, “Developed by Abraham Maslow in 1943, this iconic pyramid provides a structural guide for balancing material and spiritual needs. The School of Life explores how these five levels, from basic survival to self-actualization, remain essential for creating a purposeful and harmonious life” (AI generated summary).
According to the video, Maslow was concerned with an overemphasis on the most basic level of human need during the beginning of America’s capitalism boom. In other words, an overemphasis on physiological needs to the exclusion of psychological needs or if you will, spiritual needs. In more words, money alone cannot buy wellbeing. Perhaps Maslow had a point because following the 1940s was the 50s, which was the beginning of the psychotherapy boom.
Maslow’s hierarchy, and its pyramid illustration, are mostly common sense.
Obviously, if you are lost or stranded in a desert or forest, little else matters more than basic physiological needs of food, water, and shelter. If you are lost in a jungle, or behind enemy lines, safety is a close second. Without these two needs being met, life is not operating at a baseline where wellbeing and happiness are the primary concern. Though this is not a political post, to illustrate the pervasiveness of Maslow’s theory, it can be added that the primary job of government is to supply the means of physiological needs and safety needs, while freeing the populous to pursue love, esteem, and self-actualization. Fundamentally, while not accomplished perfectly, the American idea was created to do that and is why it is the most successful nation in the history of mankind. America’s power comes from individuals being free to become all they were meant to be (self-actualization).
Wellbeing from self-actualization comes from the fact that it is self-evident that people are created to accomplish. The human body, in every regard, is designed to work. We all know the results of a sedentary lifestyle. The cells that form our body are made to do one thing: disperse energy. The purpose of humanity is to do what we were created to do: accomplish. Spiritual wellbeing is the natural result of accomplishment.
Why is Healthcare So Toxic?
Healthcare is toxic because it supplies the possibly for cheap self-esteem. It supplies the possibility for pseudo-self-actualization. The antithesis of true self-actualization is hedonism, and hedonism strives to function on Maslow’s lowest level only. In other words, these are lazy people who just want physiological needs met, including various and sundry lusts, and want to have spiritual welling for free. They do not understand that spiritual wellbeing is not free. What does this look like in nursing?
It looks like fast money (= physiological needs) and instantaneous self-esteem and respect because of a mere title. Florence Nightingale and the nursing culture she created still demands a lot of respect in our world. Today, you can have all that respect and the money that comes with it for a year of sacrifice. Yes, even though an LPN diploma is no walk in the park, let’s also remember that cheating in nursing school is prolific. Also prolific is fake nurses who purchase nursing degrees.
The result? A healthcare culture full of nurse aides and nurses who are only there for the money and only functioning on the lowest level of humanity. They are not concerned with the next level up of safety because they are bullies and predators. They do not need love and belonging because they are narcissists who belong to a healthcare click of other bullies and thugs. They do not need self-esteem because all of their self-esteem is vested in their title. Lastly, they define their self-actualization in the fulfilment of their lusts.
But, there is one thing that they cannot hide: their presentation. They are unprofessional, adorn themselves in outer things they think impress people, lack compassion and empathy, and do not impart life into other people. In contrast, people who are intentionally or intuitively building Maslow’s hierarchy into their lives have an entirely different presentation and demeanor. People who are advancing on all levels of Maslow’s hierarchy are life-builders. Dilapidated shacks do not like to exist beside tall skyscrapers that reflect the morning sun. Hence, the toxicity. And, I believe the toxic minority are the primary reason for nursing staff shortages; the toxic minority are driving the real nurses out of healthcare. And of course, the propensity of state nursing boards to lower standards will exacerbate the problem further.
Survival
Examining how Maslow’s hierarchy should function is the key to keeping real nurse aides, nurses, and future doctors in healthcare. First of all, Maslow’s hierarchy does not apply to the afterlife. Maslow’s hierarchy is about practical wellbeing in this life. And by the way, God is not opposed to practical living that leads to wellbeing. In fact, living up to everything God created you to be may be the highest respect you can show Him. One can love Jesus and believe in Him with all of their heart, soul, and mind, and live a defeated life at the hands of others.
In order to put feet on this idea, let’s use Maslow’s hierarchy to judge the worthiness of a job we may be considering. Will the job meet physiological needs for the season of life that you are in? Is the job safe? And if it isn’t, does the risk outweigh the benefits? Does the organization create a culture of belonging? Are there people there that you can trust and network with? Are there people there that enhance your self-confidence?
Self-Esteem
Self-esteem requires a separate examination. Self-esteem is a factual assessment of how well a person is life-building according to the individual’s self-assessment. No one knows you better than you. You are the project manager of your own life-building program and no one else. Why is this important to know? Because a desire to control others is the essence of sin, and this is usually accomplished through criticism. It goes something like this: “Because I am smarter than you, or more moral than you, or more experienced than you, or more educated than you—you need to let me control you.” For the most part, criticism is used to diminish self-esteem for purposes of control. Teaching, instruction, and correction can always be done without criticism, and be aware of the term, “constructive criticism.” Criticism never builds anything. And for certain, criticism is the wrecking ball that dilapidated shacks use to tear down shiny skyscrapers.
Projection
There are also false accusations. Since life-builders have a short list of faults, hedonists and narcissists have to makeup false accusations to tear down life-builders that make them look bad. The best list of accusations to use are what they know about themselves. Hence, they will routinely accuse others of what they are guilty of. This is projection.
Burnout
Burnout occurs when a job is not contributing to a person’s self-actualization. This is the very definition of job burnout. Redundancy rarely contributes to a sense of accomplishment.
Competition
The key to Maslow’s self-actualization is the goal: being everything you alone are meant to be and created to be; connecting to your inner self-destiny. You are only in competition with yourself. Wanting to be someone else is the antithesis of self-respect and self-esteem. If you don’t want to be you—that’s a problem. If you don’t like you—change it, that’s what self-actualization is all about. If you are in competition with anyone but yourself, jealously will soon follow and is never found to be a healthy emotion.
However, please note: if you are in the process of striving for self-actualization, more often than not, you will be recognized as stellar wherever you are. The reason for this is well stated by seven-time Superbowl champion Tom Brady: “To be successful at anything, the truth is you don’t have to be special. You just have to be what most people aren’t: consistent, determined, and willing to work for it.”
Lastly, if you care to bring religion into this matter, remember that in the final judgment, only you and God will be there; you alone will be responsible for the sum and substance of your life. What others told you about yourself will matter little, and you will not be judged negatively for not being someone else.
And, of course, toxic healthcare workers never judge others for what they bring to the table because that builds others up, and they are in competition with everyone to make sure their life-building project is not exposed for what is by comparison. And invariably, if you don’t first and foremost judge everyone for what they bring to the table for the benefit of caring for others, you will eventually hate everyone.
Conclusion
For certain, using Maslow’s hierarchy for a company HR model would be ideal. Does our employment supply basic needs? Are people safe while working for our company? Does our management style create fear of termination? Do we cultivate a culture of belonging? Do we cultivate self-confidence? Do we refuse to employ toxic people? Do we supply upward mobility? Though this is rare, possibilities for any job to contribute to self-actualization is likely because the concept is intuitive and the possibilities will exist by accident on the part of many healthcare agencies. For certain, this will be true of the nurse aide discipline because Maslow’s hierarchy is the focus of basic care, and I would argue the very foundation of care.
Furthermore, all abuses and neglect can be defined as antithetical to Maslow’s five levels and categorically defined by them.
But Maslow’s hierarchy is particularly relevant to selfcare and the survival of the worker in healthcare.
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