Nursing Center - Journal Issue

Abstract

Generation Y nurses represent the new nursing workforce. This article describes a study examining the needs, motivations, and expectations of generation Y nurses at the start of their careers. New nurses, on average 24.1 years old in 2007, were interviewed. The generation Y nurses reported that recognition was a key motivator. Their needs are stability, flexible work schedules and shifts, recognition, opportunities for professional development, and adequate supervision.

The current nursing shortage has been documented throughout the world and is likely to peak in coming years with the retirement of the baby boomer generation. Interventions to mediate this shortage have been proposed by the World Health Organization (2006), which suggested that an effective workforce strategy must focus on improving recruitment, helping the existing workforce perform more efficiently, and slowing the rate at which healthcare workers leave the labor market. The increase in admissions to nursing education programs, one proposed intervention (Advisory Committee Health Delivery and Human Resources, 2003), will only prove fruitful if these new graduates, members of generation Y (born between 1980 and 2003), can be successfully integrated and retained on nursing teams. To date, little is known about the needs, motivations, and expectations of generation Y (also known as Nexter or Net generation) nurses (Stewart, 2006) at the start of their careers. This qualitative study aimed to investigate their perspectives and experiences, with the ultimate goal of creating innovative interventions for nursing educators and managers to help retain these new recruits in healthy work environments.

LITERATURE REVIEW

The Current Work Context

It is clear that new nurses are arriving to tumultuous work environments that have the potential to influence their work satisfaction and ultimate desire to remain in the profession. An aging population has resulted in patients requiring complex care in an environment affected greatly by short staffing. Indeed, it is estimated that by 2011, Canada, for example, will experience a shortfall of 78,000 nurses (Canadian Nurses Association, 2002). The global situation is not any better. Although increasing the number of nursing graduates has been posited as one means to palliate the shortage (Baumann, Yan, Degelder, & Malikov, 2006), increasing the retention of new nurses to the healthcare workforce must also occur to avoid a revolving door situation.

Unfortunately, many new graduates are leaving the profession in the first years after graduation. The problem is such that a recent study of new nurses from Quebec, Canada, revealed that 61.5% intended to quit their present job for another job while remaining in the profession and 12.9% were considering leaving the profession altogether (Lavoie-Tremblay, O'Brien-Pallas, Gelinas, Desforges, & Marchionni, 2008). A similar finding was reported in U.S. nurses where 30% left their initial position within the first year of work. Twenty-two percent of respondents cited the work environment as the reason for leaving their first job. Specifically, new nurses reported that they lacked support and guidance and were given too much responsibility too soon, a problem inherent with rapid turnover of staff, where new nurses often find themselves as the "senior" nurse on the unit (Bowles & Candela, 2005). In addition, new nurses are arriving fresh from school to work environments where four clearly different generational cohorts are working together: veterans, baby boomers, generation X, and generation Y. It is essential for nurses working in staff development to understand the similarities and differences between each generation to target interventions to promote harmonious, healthy work environments to retain new employees.

A Generational Perspective

It is thought that individuals born within close proximity to each other share similar motivations and values (Hicks & Hicks, 1999). A generation is "an aggregate of people who share birth years, a common location in history, and a collective persona" (Kupperschmidt, 2001, p. 570). Individuals who occupy a given generation are thought to share similar backgrounds and even experience greater comfort interacting with one another (Hu, Herrick, & Allard Hodgin, 2004). Generations generally span about 20 years, but it is clear that individuals born during "border years" may share characteristics with both groups. Furthermore, there is no consensus on the exact start and end date of each generation (Foot & Stoffman, 1998; Tapscott, 1998; Zemke, Raines, & Filipczik, 2000). Although the bulk of registered nurses in Canada fall into the baby boomer generation with an average age of 45 years (Canadian Institute for Health Information, 2008), generation X and Y nurses are the up-and-coming reinforcements. There are particular challenges in nursing work environments where currently four different generations work together and an understanding of the idiosyncrasies of each group is essential.

The veterans

Born before the Second World War, between 1925 and 1945, this generation has also been called the silent generation. Nurses in this cohort have experienced the Great Depression and world war during childhood. Nearing retirement, they are highly respectful of authority and hierarchy and are used to clear divisions of labor (Weston, 2001). These nurses value hard work and discipline, although they have been labeled conservative and slow to adapt to new work methods and technologies (Zemke et al., 2000).

Baby boomers

The largest number of nurses in North America fall into the baby boomer generation, and it is expected that they will dominate the workforce until at least 2015 (Weston, 2001). These individuals were born into postwar prosperity between 1946 and 1964. They were raised in traditional nuclear families and witnessed great technology changes. This generation was brought up thinking that they could change the world, having witnessed and participated in civil rights protests in the 1960s. Boomers thus question authority and derive a sense of self-worth from their contributions to their selected professions. They value creativity and risk taking but have adapted slowly to changing technology (Widger et al., 2007). Workaholics, today's baby boomers, can easily be found working 12-hour days while caring for young children (as child rearing was postponed for career advancement) and aging parents (Apostolidis & Polifroni, 2006).

Generation X

It has been noted in discussions of generational differences that positive and negative traits are often assigned to each group. Mensik (2007) noted that, although boomers are "dedicated and driven," generation Xers are "lazy, demanding, cynical and detached" (p. 483). These negative stereotypes do not help improve relations between cohorts and do not facilitate the teamwork required for safe nursing care. Clearly, members of generation X, born between 1965 and 1980, had vastly different experiences compared with their older peers. This is the generation of "latchkey" children, where 40% were raised in single-parent families (Strauss & Howe, 1991). Raised in an era of recession, the AIDS crisis, and "hands-off" child rearing, generation Xers are self-reliant and independent. They place tremendous value on work-life balance and will change jobs frequently to achieve their own goals (Stewart, 2006). Technologically savvy, generation Xers expect "instant gratification" (Apostolidis & Polifroni, 2006, p. 507). Self-directed, they prefer coaching and mentoring and are motivated by continuous education and training.

Generation Y

Also termed Generation Net, Millenials, and Nexters, this group now represents 12% of the U.S. workforce (Glass, 2007). The new nurses from this generation, born after 1980, experienced prosperity and a new emphasis on family values that differed from their older peers (Stewart, 2006). Generation Y does not know a time without the Internet and instant text messaging, rendering them confident with technology and expecting immediate feedback and information. Adept at multitasking, it is thought that generation Y crave stimulation and are easily bored (Arhin & Cormier, 2007). They appreciate a team-based collaborative approach to work given their educational experiences where interdependence and networking were emphasized (Kupperschmidt, 2001). Having witnessed their parents undergo organizational downsizing, members of generation Y have little company loyalty but recognize that training and development are the means to establishing a solid career path (Alch, 2000). Like generation X, they too strive to seek a balance between work and family life (Zemke et al., 2000). Fortunately, Generation Net, who grew up with social service programs integrated into their schooling, may be particularly drawn to careers in health care. It is up to managers and nursing educators to capitalize on this sense of altruism and create work environments that meet their needs for constant feedback and for control over their fast-paced, technology-dependent working lives (Kupperschmidt, 2001). The first group of generation Y nurses has just entered the nursing profession and is being integrated into a work environment colored by short staffing, heavy patient loads, and the ubiquitous shift work. To date, little is known about how new generation Y nurses perceive their working conditions. This qualitative study employed semistructured interviews to examine the needs, motivations, and expectations of generation Y nurses at the start of their careers to identify retention strategies that could be applied to this group.

METHODS

This qualitative study was conducted in six acute care hospitals in Quebec, Canada. Focus groups and semistructured individual interviews were conducted with new generation Y nurses in 2007. New nurses were eligible if they were 27 years or younger and had been working as nurses for no more than a year. Six individual interviews and 11 focus groups (with two to four participants) were conducted, resulting in a sample size of 35 new nurses. Of this group, 31 (88.6%) were women, and the mean age of the respondents was 24.1 years. Seventeen (48.6%) participants had received technical college degrees in nursing, 16 (45.7%) held bachelor's degrees obtained at the university level as their first nursing qualification, and 2 (5.7%) had master's degrees in nursing. Eleven (31.4%) participants had permanent full-time jobs, 13 (37.4%) had permanent part-time jobs, 8 (22.9%) held occasional part-time positions, and 3 (8.6%) had temporary full-time positions. In all, 11 (31.4%) of the participants worked a fixed evening shift, 10 (28.6%) had a fixed day shift, 6 (17.1%) were on a fixed night shift, and 8 (22.9%) were being rotated through shifts. Participants averaged 10.0 months of work experience.

Procedure

Ethical approval was obtained from the university and ethical review boards of the participating institutions. The director of nursing and head of the nursing orientation programs encouraged recruitment to the study by identifying eligible new nurses and handing out information letters inviting them to take part. Nurses interested in having more information were contacted by the researchers and provided details about the study. The study was explained to each participant verbally by the researchers, and written informed consent was also obtained. To protect confidentiality, each participant was identified by a code. The interviews and focus groups lasted 45 minutes and were conducted by the researchers in a private area within each facility.

Semistructured interview guide

Because the study was descriptive in nature, the analysis was primarily guided by the interview questions rather than by a specific theoretical paradigm (Polit & Hungler, 1999). An interview guide served as the data collection tool for the interviews and focus groups. The main themes addressed were motivations and needs at the beginning of employment, strategies for retaining younger workers, and intergenerational issues. A sociodemographic profile was recorded at the start of each interview and focus group.

DATA ANALYSIS

Interviews were audiotaped and transcribed. The data generated by the interviews and focus groups were analyzed using NVivo (QSR International Pty Ltd, Doncaster, Australia) with the method proposed by Miles and Huberman (1994). Following this method, data analysis consisted of three concurrent streams of activities: condensing the data (coding of individual interview data to identify major themes and categories), presenting the data (data display of themes from all interviews), and elaborating or verifying the data. Two researchers independently coded the transcripts from a set of data to ensure consensus and met regularly to discuss data analysis and interpretation. The common themes that emerged from all the interviews were combined.

RESULTS

Motivation

The generation Y nurses reported that recognition was a key motivator. This was true of both monetary and peer recognition. For example, one nurse stated, "We need monetary incentives because, the way I see it, we aren't paid enough for the work we do."

More than once I've been told, "You've got a head on your shoulders, you're a good nurse, you're doing fine!" Someone told me that the only recognition we get is from patients. Of course that's nice, it always feels good to be thanked and appreciated, but we need more than that.

Needs

According to participants, they need to be challenged. To be challenged, certain needs must be first addressed at the start of employment. These needs are stability, flexible work schedules and shifts, recognition, professional development, and adequate supervision.

Stability

New nurses want to work on the same unit every day as opposed to "floating" from one unit to another. This will facilitate their relationships with members of their work team.

Stability makes for better care and allows us to build relationships with people and get to know experienced nurses. Experienced nurses will communicate more readily[horizontal ellipsis]they'll trust us more because they'll see us in action for 2 days in a row. This helps us build relationships[horizontal ellipsis]and friendships. And it makes it easier for us to work more independently in the hospital. And we'll be more comfortable asking questions.

Flexible schedules and shifts

At meetings with participants, the discussions often turned to work schedules. On one hand, a new nurse wants to know the long-term schedule to plan activities yet also wants some shift flexibility to be able to respond when something unexpected arises in personal life. New nurses would like to be able to adjust their schedules to their needs rather than organize their needs around their schedules: "If I have something I need to do, I want to be able to make plans without wondering whether I'll have to work because I haven't received my schedule."

Recognition

In terms of recognition, new nurses admit that this is likely a need perceived by nurses of all ages, but that it is an undeniable requirement in terms of their own work. It serves as a potent motivator as well. Recognition mechanisms must thus be implemented. Currently, this need for recognition is met through a nurse's contact with people, but for younger nurses, this is not enough. Other suggestions for recognition are, "congratulating us, recognizing our know-how and skills, or offering pleasant work conditions are ways to show us that we do matter."

I think that we need a minimum amount of recognition; a committee or someone in particular should be examining this issue[horizontal ellipsis].There is a lot of dissatisfaction, promises are made about work conditions, but they aren't kept[horizontal ellipsis].At one point, you get fed up; it's discouraging and demoralizing. You no longer get up in the morning and say, "I like working here."

Training

New nurses are constantly confronted with situations for which they feel they are not necessarily prepared or that make them uncomfortable. Some respondents suggested publishing a "guide for new nurses" that would answer frequently asked questions. Others stated, "We need continuous training and updates," and "There should always be someone on each unit who is able to answer the questions of new nurses."

Coaching and feedback

New nurses see coaching as a vital need. Coaching is more than guidance provided during the first days or weeks; participants refer to long-term coaching.

It's about sitting down and being given a report on how I'm doing as a young nurse. It's about telling us what our strengths and weaknesses are[horizontal ellipsis].I'm sure that we don't see everything, and I'd like to know what we're missing.

Key Strategies to Retaining Generation Y Nurses

In terms of retention strategies, new nurses were very clear. They want to specialize, continue studying, choose a work environment based on its reputation, and achieve a sense of belonging with the other generations who work on the care team. Some nurses are interested in specializing in a field of nursing, whereas others want to return to the classroom during their first year of employment to further their knowledge and move ahead within the organization. However, some institutions do not necessarily make it easy for nurses who wish to continue their studies. One respondent stated, "I asked for a study leave; they refused, so I resigned."

The tendency for new-generation nurses to choose a work environment based on its reputation has led institutions to position themselves in a highly competitive market. New nurses want to be able to choose where they will work because each institution offers different working conditions. New nurses choose their workplace based on the facility's reputation, its proximity to school or home, and the opportunities it offers for specialization.

I am staying here because of the facility's leadership position; there are many activities going on here, both in nursing and in research and development.

I live [in the city], so it's convenient to work here. It means less commuting.

Whether it's here or in another hospital, it doesn't matter much to me; it's the specialty that interests me. This is what I wanted to learn.

The care environment is relatively unimportant; it's the team that really matters. The team often makes the difference between whether or not you feel like going in to work[horizontal ellipsis].If you don't feel like the team is glad to have you, you're not enjoying yourself, there are personality conflicts, things like that. As far as I'm concerned, the basis of work-any work, for that matter-is the team and the work climate.

New nurses tend to leave a door open in case they fail to find what they were looking for with their career choice. They may become teachers, become self-employed (start a business), or simply change workplaces.

I'm very enterprising; I like to be my own boss[horizontal ellipsis].I'm the type of person who could own a business providing home care or something like that.

Yes, I like it here in this specialty, but if I get fed up, I can go anywhere. They're looking for nurses everywhere, there are many other challenges offered elsewhere. So I don't think I'll ever get tired of it.

Finally, new nurses also addressed intergenerational issues. For some, the appearance of intergenerational conflict is tied to the employment situation, which has changed from one generation to the next. These changes have created tension between the generations. Simply, more jobs are available to today's nurses than for older generations when they entered the market many years ago.

My feeling is that [the conflict] is tied to working conditions. The hospital offers us so much as new employees that it makes the senior nurses a bit jealous.

There was no work back then. Those nurses worked a lot, they've worked all their lives, and they've all worked on holidays. I start a new job hoping there's an opportunity for a day shift[horizontal ellipsis]and I get one!

Harmonious relationships are promoted when each generation understands one another and perceived injustices are addressed. Thus, these results provide insight into potential interventions that can be undertaken to promote retention.

DISCUSSION

Nurses working in staff development and managers are very interested in knowing how to retain generation Y nurses once hard-earned efforts to recruit them have proven fruitful. Indeed, results from this study suggest that new-generation nurses are quite selective in their choice of workplace and will choose a work environment that best meets their perceived learning needs or that simply is located close to home. Unfortunately, a recent systematic review revealed a dearth of well-constructed, experimental studies examining interventions to retain new nursing graduates (Salt, Cummings, & Profetto-McGrath, 2008). Among possible interventions, the initial orientation program for new nurses was found to influence retention. A preceptor-based program where new nurses from generation X or Y and even baby boomers were paired with a senior nurse providing individualized guidance for a 3- to 6-month orientation period was found to result in an 86% to 90% retention rate after 1 year compared with controls who did not receive the orientation (Beecroft, Kunzman, & Krozek, 2001). In fact, the longer the program, the better the retention rates. Although this study included new nurses from multiple generations, some nurses who were on the X-Y generation border were represented. Preceptor-based orientations are likely necessary and beneficial for all new hires. The nurses in this study indicated that they were constantly being confronted with situations for which they felt unprepared and that this was a source of stress for them. The nurses requested long-term supervision and regular feedback to help them work on their strengths and weaknesses. Indeed, regular feedback from a senior nurse in the context of a formal preceptor-preceptee relationship would meet these needs to know "how am I doing?" However, Salt et al. (2008) cautioned that more studies are necessary to draw conclusions about the optimal length and design of such programs.

New nurses from generation Y also want a job that will meet their need for flexibility and give them the opportunity to pursue other interests. Nurses reported that they wanted to be able to seek specialized nursing certification and training, and others sought to continue their studies while working. This is not surprising given that generation Y recognizes that training and development are the key to advancement (Alch, 2000). Employers who recognize this and make allowances for employees to work part-time while studying, for example, may retain more nurses than others. Nurses in this study indicated that they valued work-life balance and wanted to be able to adapt their work schedule to their life and not vice versa. Indeed, members of this group want to be able to work part-time and often stated that they chose their workplace based on its proximity to home or school, allowing them to achieve a more balanced home-work life (Zemke et al., 2000). The key to retaining these employees will be to create customized training and career paths with incentives and responsibilities that are matched to individual needs (Martin, 2005).

Participants in this study expressed the need for peer and supervisor recognition. It has been shown that an imbalance between perceived rewards and effort expended on the job is associated with increased levels of psychological distress among new-generation nurses (Lavoie-Tremblay et al., 2008). The lack of recognition (a potent reward) could be a source of distress. Therefore, nursing educators and managers need to ensure that adequate and systemic recognition programs are in place to ensure retention. Formal and informal on-the-spot recognition of a job well done also meets generation Y's need for frequent and daily feedback (Martin, 2005).

STUDY LIMITATIONS

This study was conducted in six publicly funded French acute care hospitals in different geographic locations in Quebec, Canada. Thus, the results may have limited generalizability to for-profit institutions and those located in other regions of North America. Despite the small sample, the themes that were derived from the analyses have appeared in other studies of generation Y nurses (Lavoie-Tremblay et al., 2008).

CONCLUSIONS

The results of this study suggest that generation Y nurses have unique needs that must be addressed to promote retention and highlight some implications for nurses in staff development and management. First, it is necessary to recognize generation Y's needs and motivations and create individualized, tailored career development programs (e.g., nursing specializations) for these new employees. For example, continuing professional development programs in which nurses spend 80% of their salaried time in direct patient care and 20% of their time on professional development can promote retention (Bournes & Ferguson-Pare, 2007). Finally, it is essential to recognize the technological savvy inherent in this generation and offer them the opportunity to use these skills independently while providing them with the feedback and encouragement they require to become skilled nurses. In the context of the current nursing shortage, it is of critical importance to develop partnerships between policy makers, decision makers, nursing unions, managers, and educators to implement sustainable retention strategies targeting generation Y. Such a partnership is exemplified by a provincial government initiative to implement mentoring programs for new nurses to ensure a smooth integration into the workforce for these recent graduates. These partnerships must also ensure that new recruits work with stable teams on fixed nursing units to allow them to develop their confidence and competencies in a nurturing environment. Although attracting new nurses to the profession will go along way in addressing the shortage, it is by far only the first step. We must create healthy work environments that will allow these young nurses to make long-lasting contributions to the profession.