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  1. Frontliners and the Hero–Recipient Exchange

Frontliners and the Hero–Recipient Exchange

The traits assigned to heroes by beneficiaries of heroism are important because, according to our DNE model, the act of bestowing the label of hero is a commodity in an exchange relationship between heroes and recipients of heroic action. Central to the implied relationship is the idea that the hero designation is a valued “good” in the transactional exchange. Heroes and recipients of heroism are two parties honoring an implicit contractual arrangement (Sumner and Kinsella 2021), with recipients more likely than heroes themselves to embrace this unwritten understanding because recipients enjoy the benefits of heroism while incurring far fewer costs compared to heroes (Allison and Goethals 2019). According to our DNE model of heroic leadership, the nature of this contractual exchange relationship is always dynamic, showing mild flux during normal circumstances and becoming subject to extreme change during times of crisis. The very nature of crisis, we argue, is likely to upset the “equilibrium” of exchange that Messick (2005) referred to in his social exchange model of leadership.

One important consequence of this equilibrium change during crises is that when inequities in the distributions of outcomes within the exchange relationship shift to significantly disadvantage one of the parties in the relationship, the terms of the hero contract will become especially salient to the aggrieved party. If heroes were not as mindful or consciously aware of the existence of the hero contract before a crisis, the fallout from the crisis will bring the terms of the contract into the forefront of the hero’s consciousness.

During the COVID-19 pandemic, there was ample anecdotal evidence that health care workers began to resent and reject the existing implicit exchange agreement between heroes and recipients. We began this article with the story of a nurse, Cassie Alexander, who both recognized and rejected the commodity value of the hero designation conferred on her. In fact, she pointed out two important realities: (1) the reality of the failure of the hero label to improve the quality of nurses’ lives, and (2) the reality of the hero label justifying the inhumane working conditions of health care workers. “America pretended healthcare workers were heroes and then made us feel disposable,” Rose (2020, 1) wrote. Echoing this sentiment, physician Carolyn Rose recalled that during the early stages of the pandemic, health care workers were compelled to “reuse single-use equipment, make do with handmade and untested masks, provide care with little to no protection at all” (2020, 1). Rose also recognized the implicit exchange between heroes and recipients and expressed disdain for it. She even outlined the unacceptable terms of the agreement, mocking its terms. In the agreement, “society owes you a debt of gratitude,” Rose (2020, 1) wrote. To pay this debt, “if you succumb to the virus, we will sing your praises to your children. They will know what a hero you were” (Rose 2020, 2). Finally, Rose noted that the implicit hero–recipient contract was ultimately unsustainable: “The ‘healthcare hero’ meme is just another way to keep doctors and nurses chained to a sinking health care system” (2).

Health care workers also made it clear, in both tweets and blog posts, that the only equitable exchange between themselves and the public is one in which the workers do their jobs and, in turn, are given the proper tools and resources from their employers to do their work safely and effectively (Sumner and Kinsella 2021). According to Yong (2021), during the pandemic health care workers felt like “a commodity” to their hospitals and to the public who downplayed the pandemic despite factual evidence indicating a terrible crisis. “It’s like it takes a piece of you every time you walk in [the hospital],” said Ashley Harlow, a Virginia-based nurse practitioner who eventually left her ICU to preserve her mental health (Yong 2021, 1). Health care advocate Amel Murphy wrote, early in the pandemic, that “we were already drowning when we hit the proverbial iceberg that is COVID19, and now we are doing so more rapidly and very publicly. Do not ask me to risk my life. Provide me the tools and necessary equipment to do my job while keeping me safe” (2020, 1). This final statement sums up Murphy’s dissatisfaction with the unfair exchange between heroes and recipients: “I live with a superhero burden” (Murphy 2020, 1), she wrote, with the burden clearly referring to the inadequacy of the hero label in addressing the true needs of frontline workers.

Within weeks of the onset of the COVID-19 crisis, Justin Jones (2020), an outpatient doctor in Utah, asked that the hero label be banned from the public’s vocabulary, arguing that while the label seemed like an effective form of encouragement to frontliners, it was ultimately doing more harm than good. In their research on the mental health trauma experienced by health care workers, Kinsella and Sumner wrote that “the labelling of frontliners as heroes has also coincided with other gestures such as Clap for the Heroes and the awarding of medals, which over time have become viewed by many frontline workers as disingenuous—particularly where the appreciation does not lead to real action to improve their working conditions, or worse, when the apparent appreciation gestures are coupled with blatant disregard of public health advice making these conditions deteriorate” (2022, 198). Kinsella and Sumner (2022, 198) also accuse hospital leadership and the public of using the term “hero” strategically “in a way that lets them ‘off the hook’ from their responsibilities.” Cox also argued that “the heroism narrative can be damaging, as it stifles meaningful discussion about what the limits of this duty to treat are. It fails to acknowledge the importance of reciprocity, and through its implication that all healthcare workers have to be heroic, it can have negative psychological effects on workers themselves” (2020, 510).

From these considerations, it is clear that an important component of both doing and receiving heroic work is the phenomenon of agency, defined as one’s capacity to take action to achieve one’s aims (Bandura 2000). The implied hero contract endowed both heroes and recipients of heroism with high agency under normal, noncrisis situations. Because the COVID-19 pandemic shocked the health care system in unprecedented ways, this agency was transformed, diminished, or even eliminated, causing feelings of stress, burnout, anger, and helplessness in heroes (Sumner and Kinsella 2021). Recipients of heroism also experienced reduced agency during the pandemic, accompanied by many of the same emotional deficits experienced by frontline heroes.

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