Authors

  1. Martin, Erik R. DNP, RN, CNML
  2. Kallmeyer, Robert PhD

Abstract

OBJECTIVE: The purpose of this study was to explore how generational differences contribute to challenges in recruiting the next generation of talent into nursing administration roles.

 

BACKGROUND: The current workforce is aging. Nursing administrative roles, which for the purpose of this study are defined as nurse managers, are increasingly difficult to fill with leaders from upcoming Generations X and Y.

 

METHODS: A descriptive, nonexperimental study was undertaken using a convenience sample. An electronic survey was distributed to explore the impact a set of interventions would have on recruiting into nursing administration roles. Then differences between generations were analyzed.

 

RESULTS: Respondents indicated 45% of the interventions have a moderate to high impact on their consideration for a position in administration. Statistical significance between generations was identified on 4 interventions related to work-life harmony.

 

CONCLUSIONS: Fiscally conservative interventions exist to assist hospital administrators with succession planning among nurse managers. When recruiting Generations X and Y candidates, interventions supporting work-life harmony should be emphasized.

 

Article Content

Many of our current nursing managers (NMs) are approaching retirement. As they exit our workforce, a serious shortage of NMs is predicted. In fact, a national shortage of nearly 67 000 NMs is predicted by 2020.1 Nursing management positions are competing with the schedule flexibility and autonomy offered to bedside clinicians, research nurses, advanced practice nurses, and nurse educators. Current nurse administrators are challenged to make the NM role more attractive to the younger generations or face a serious shortage of talented leaders in nursing management.

 

The scopes of responsibility for an NM are defined by an organization2 as well as by national professional organizations such as the American Organization of Nurse Executives (AONE). AONE bases the NM competencies on the Nurse Manager Learning Domain Framework. This framework identifies 3 domains a NM must gain expertise in to be successful: The Science: managing the business; The Leader Within: creating a leader within yourself; and The Art: leading the people.3

 

Span of control for full-time equivalents (FTEs) varies as well. The literature reports numbers of FTEs per NM can reach as high as 200 FTEs, and many have more than 1 complex patient care area.4,5 Despite their pivotal role in creating environments that support professional nursing practice and safe patient care, many organizations do not routinely monitor retention, turnover, time-to-fill, or vacancy rates of NMs. Evidence suggests that although NMs may be satisfied with their roles,5 role overload leads to stress,4,6 and many opt to leave their positions.5,6 With an average tenure of 5 years reported for NMs,5 succession planning for NMs is critical to ensuring stable, healthy work environments for nurses.

 

The different values, beliefs, and perspectives of generations have added unique challenges in the current workforce. Generational differences among nurses are leading to a significant decline in the ability to recruit talent into NM roles. NMs from varying generations are also charged with creating environments that are attractive and satisfying to workers of all generations, which is also often a challenge.7 Currently, Baby Boomers constituted the majority of NM positions1; however; nurse leaders must consider Generations X and Y as potential resources for future leaders.

 

Data support that employees in Generations X and Y are not asking to do less work; they are seeking permission to do the same work differently. They value autonomy, flexibility, and work-life balance, as well as organizational support to be successful nurse administrators.8

 

Literature Review

Defining the Multigenerational Workforce

For the 1st time in history, there are up to 5 generations in the workplace.9 As quickly as the Veterans and Boomers exit, Generation Z is entering. For the purpose of this article, the focus will be on the 3 most predominant generations in the current nursing workforce: Baby Boomers, Generation X, and Generation Y. It is widely accepted that the Baby Boomer generation consists of those born between the years of 1946 and 1964; Generation X individuals were born between 1965 and 1982; and Generation Y or the Millennials were born between 1983 and 2001.10

 

Each of these generations is defined with significant events that occurred in critical stages of their lives shaping perspectives, values, and morals.11 Each generation has been molded and influenced by the society and environments in which they were raised. The result of these influences has led to significant differences in perspectives and behaviors related to career, family, and overall life balance. As a profession, nursing has been more sensitive to cultural diversity rather than generational attributes such as the differences in work values, educational attainment, and age.12

 

Leading Through Generational Differences

Multigenerational workforces present challenges for leaders and organizations. It is recognized that each generational group benefits from unique orientations, training, advancement opportunities, and benefits.13 Key differences between generations that contribute to increased attrition in the workforce are perceptions of leisure, hard work, work ethic, and delayed gratification.14 Generational differences also exist between Generations X and Y nurses and the level of stress they experience in relation to the type of resources available including emotional, cognitive, and physical.15 A unique difference between Baby Boomers and Generation X nurses is their perception and ranking of their unit's work climate, burnout, turnover intention, physical symptoms, and incivility of their supervisor, coworkers, and team.16,17

 

Aside from the many differences that exist, there are commonalities shared among generations.7,13,14 Similarities exist between how Baby Boomers and Generation X nurses perceive their leaders' management style.16 Other similarities are that all 3 generations report preferring to receive specific, timely, and accurate feedback; they desire challenges to continually learn and grow and want to work in environments that are absent of conflict.13,15 In recent literature, leaders have been encouraged to leverage the similarities and strengths of multigenerational teams and embrace the differences each generation possesses.18

 

Recruiting Top Talent

Approximately one-third of Generation X nurses aspire to be in some type of leadership position; however, only 7% strive for senior- or executive-level positions.19 A direct reflection of this statistic is that enrollment into formal nursing administration programs is decreasing.20 Barriers preventing graduate students from enrolling in a nursing administration track include lack of management support, organizational politics, demands of their role, inflexible work hours, loss of clinical experience, lack of supervisor support, and no perceived financial reward.20 Studies forecast a shortage of NMs and call for administrators to take a more active role in recruiting Generations X and Y individuals into the management workforce.1,20-22

 

There are many factors affecting career progression for nurses including lack of opportunity to develop essential skills, professional factors such as educational level, personal factors such as marital status or parental responsibilities, and work-related factors including experience. Specific interventions targeted at recruiting nurses into leadership positions include having a formal mentor program, offering job sharing, supporting flexible work hours, and offering additional educational opportunities on communication, healthcare finances, and patient relations.21,22

 

Other factors affecting recruitment into formal leadership roles are nurses' perceptions of what the role entails and how it will affect them personally and professionally. Kath et al6(p215) stated, "as clinical nurses witness the effects of NM stress, recruitment of new NMs becomes more difficult because nurses with leadership potential may opt for less stressful roles with often higher levels of compensation rather than management roles." Their study focused on the effects stress has on job satisfaction, organizational commitment, intent to quit, and physical and mental health symptoms. It revealed that NMs with high levels of stress identified the top 3 buffers to stress as autonomy, social support, and predictability.

 

Methods

Design, Method, Subjects, and Data Collection

A descriptive, nonexperimental study was conducted using a convenience sample. Appropriate institutional review board approval was secured. A form letter containing the survey link was distributed to key stakeholders of a national nursing leadership organization. All recipients of the letter were RNs. Recipients were asked to both participate in the survey and forward the e-mail on to other nurses and nurse leaders to participate. This broadened the sample to include participants outside the professional organization. The survey remained open for 30 days. The results reported in this article include participants identifying as clinical nurse or charge nurse.

 

Instrument

An electronic survey tool was designed leveraging a set of guiding principles published by AONE.23 The guiding principles were created by a diverse, multigenerational task force of nurse leaders and contain suggested actions to assist in recruiting the next generation of nurses into leadership positions.24 The guiding principles categorize the suggested actions into 5 themes using Zemke and colleagues'24 ACORN imperatives. ACORN is an acronym that stands for accommodating employee differences (modified to generational differences in the guiding principles), creating workplace choices, operating from a sophisticated management style, respecting confidence and initiative, and nourishing retention.25 A list of interventions was created for each principle, and respondents were asked to rate how impactful each intervention (from the guiding principles) would be on their intent to consider career opportunities within nursing administration. Respondents rated each intervention utilizing a 5-point Likert scale of negative impact, no impact, low impact, moderate impact, and high impact. The internal consistency reliability for the interventions in each guiding principle was acceptable, with Cronbach [alpha]'s ranging from .895 to .973. Convergent and divergent validity were acceptable overall, with interitem correlations ranging from 0.232 to 0.838 in all but 1 pair: on-site day care and job sharing/comanagement (r = 0.163). All interitem correlations with on-site day care were comparatively low, although it thematically fit its guiding principle of "Creating Choices." The survey included demographic questions to establish generation, type of organization, level of education, years of practice, race, and gender.

 

Analysis

Data were examined using the analysis of variance (ANOVA) statistical method. For statistical analysis, the scale was weighted using a numerical value: negative impact = 1, no impact = 2, low impact = 3, moderate impact = 4, and high impact = 5. Where statistical significance was noted (P < .05), post hoc tests determined which groups differed.

 

Results

A total of 287 survey respondents indicated that they were not currently in formal nursing administration roles and identified themselves as a clinical nurse or charge nurse. Of the 287 clinical nurse or charge nurse respondents, 37 did not answer any of the intervention questions, so they were not included in the analyzable sample. Also, some respondents did not rate every intervention. Thus, each intervention was rated by 215 to 250 participants. Most respondents indicated they were white and female, earned a bachelor's degree, and worked in the acute care setting (Table 1). Responses were geographically representative of all regions of the United States.

  
Table 1 - Click to enlarge in new windowTable 1 Demographics of Respondents

Of the respondents included in this analyzable sample (n = 250), 39.2% (n = 98) indicated that they were not at all likely to consider nursing administration in the future. On the contrary, 14.8% (n = 37) indicated they were either "very likely" or "highly likely" to seek nursing administration. Of the remaining, 46.0% (n = 115) indicated they either were "somewhat likely" or did not know whether they would consider a transition to nursing administration (Table 2).

  
Table 2 - Click to enlarge in new windowTable 2 Mean Impact of Interventions

The intervention scores for all generations were averaged and ranged from 3.05 to 4.29. The lowest-scoring intervention (mean, 3.05) related to having on-site day care available. The highest-scoring intervention (mean, 4.29) was "leaders who foster an environment that promotes job enjoyment and meaningful work."

 

Approximately 45% (n = 16) of the interventions had a mean score of 4 or higher, indicating respondents identified the intervention would have a moderate to high impact on their overall consideration for nursing administration. To determine if differences existed between generations for these interventions that would likely impact motivation to transition into administration, ANOVAs were conducted on these interventions as well as the highest-ranking intervention in the "acknowledging generational differences" category (Table 3).

  
Table 3 - Click to enlarge in new windowTable 3 ANOVA Results Comparing Intervention Score Between Generations

Four interventions indicated statistical significance (P < 0.05) between generations. Each of these interventions was within the principle related to creating choices to promote harmony between career and personal life. Post hoc tests were completed to determine which groups differed.

 

Post hoc tests showed that baby boomers rated "creative scheduling items" as having a statistically lower impact on their likelihood to consider administration (mean, 3.76) than the Generations X (mean, 4.29) and Y (mean, 4.29) participants. Similarly, Baby Boomers rated "the option to work remotely" as having a statistically lower impact on their likelihood to consider administration (mean, 3.67) than the Generations X (mean, 4.16) and Y participants (mean, 4.06).

 

A third post hoc test was completed for "benefit time programs that provide flexibility." The results indicated Generation Y rated this intervention statistically significantly higher (mean, 4.39) than did their Baby Boomer (mean, 3.71) and Generation X (mean, 4.18) peers. The final post hoc test was completed evaluating the impact of "financial aid or tuition reimbursement." Baby Boomers rated this intervention statistically lower (mean, 3.71) than both the Generations X (mean, 4.18) and Y (mean, 4.39) participants.

 

Discussion and Implications for Practice

Similar to other studies, the results indicate few nurses are very or highly likely to pursue nursing administration. Although this seems discouraging, there are approximately 45% of the nurses who either are somewhat likely or do not know how likely they are to seek leadership opportunities in nursing administration. This demonstrates a large portion of the nurses who with the proper grooming, mentorship, and incentives could be recruited into the administrative workforce in the future.

 

The results of this survey indicate 17 of the interventions were moderately to highly impactful in recruiting these individuals. Furthermore, several of these highly rated interventions have minimal or no cost implication for leaders or organizations. These include creative scheduling options; offering the option to work remotely; fostering collegiality and accountability across all disciplines; developing efficient and effective organizational processes; conducting meaningful meetings; providing coaching and mentoring programs; fostering professional development and socialization; fostering a broader understanding of the organization's structure; developing a manager framework that builds on the individuals skills, knowledge, and experience; and most of all fostering an environment that promotes job enjoyment and meaningful work.

 

Data suggest financial resources would be best targeted toward providing administrative assistance to ease NM workload, to continue to support and enhance tuition reimbursement programs, to offer benefit programs that provide flexibility, and finally expand coverage to include presence of NMs with authority on the off-shifts to assist with 24/7 operations. In terms of generational attributes, 2 themes emerged. First, many similarities exist among the generations in the nursing workforce. Regardless of the generation in which an individual was raised accountability, collegiality, adequate resources, and efficient and effective work processes ranked high. All generations value strong teamwork and efficient use of time and resources.

 

Some key differences among generations are also reflected in the data. The interventions related to work-life harmony are the most impactful to Generations X and Y and the least impactful to Baby Boomers. Specifically, interventions related to creative scheduling options, the option to work remotely, and tuition reimbursement were rated statistically significantly higher by both Generations X and Y.

 

These results could indicate that Baby Boomers who are nearing retirement are less likely to take advantage of benefits such as tuition reimbursement, whereas those younger in their career would consider furthering their education as a priority. Additionally, interventions related to working remotely may be more appealing to Generations X and Y who have reported a larger affinity to technology and electronic connectedness.

 

One potential reason why flexible scheduling ranks higher among Generations X and Y could be related to both of these generations having joined nursing during a time when 12-hour shifts and 3-day work weeks were the norm. According to Sherman,26 12-hour shifts were introduced during the 1980s to address the nursing shortage. However, nurses quickly became fond of them as it improved their work-life harmony. Generations X and Y's reluctance to transition to 5-day work weeks and 24/7 accountability could be related to the benefits and flexibility of their current work schedule.

 

Limitations

Limitations of this study include the sample being predominantly from the acute care setting and mostly white. Additionally, the survey instrument was independently developed and should be repeated on additional samples to verify its psychometric properties. Future studies should seek adequate representation of settings outside acute care and a sample that is reflective of the current nursing workforce spread. Finally, the study did not explore whether differences in rankings were related to age versus generation. Future studies of Generations X and Y as they advance through their career will help evaluate if the level of impact for each intervention remains equally valuable.

 

Conclusion

Because of the retirement of baby boomers, by 2020 a national shortage of NMs is predicted.1 Attributes of this generation indicate they prefer stable environments, are defined by their career, and are often self-proclaimed "workaholics." In contrast, the upcoming Generations X and Y individuals want to achieve work-life balance, desire autonomy, and value strong relationships with their coworkers.

 

This study offers nurse administrators and other organizational leaders a set of interventions that would have demonstrated a moderate to high impact in recruiting the next generation of talent to NM positions. The vast majority of these actions could be implemented at no cost to an organization. Consistent with previous research and studies, the most impactful of these interventions is centered on promoting a healthy work environment, accenting on individual strengths, promoting an environment of learning, allowing autonomy in practice, and being flexible with schedules. Nursing leaders are encouraged to consider interventions that promote work-life harmony as most important when considering Generation X or Y for recruitment into NM positions.

 

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