Keywords

Gen Y, Gen Z, millennial, nurse, retention

 

Authors

  1. McClain, Ashley R.

ABSTRACT

Objective: The objective of this scoping review is to explore the existing literature related to millennial nurse retention strategies and barriers; to examine and conceptually map the evidence; to extract any differences between nurse retention strategies and barriers for Generation Y and Generation Z; and to identify any gaps in the literature.

 

Introduction: The millennial generation has become the largest group of nurses in the workforce and, as nursing leaders grow to understand their tendency to change employers frequently, it is important for organizations to identify and implement retention strategies and reduce retention barriers for this generation.

 

Inclusion criteria: This review will consider studies that include registered nurses born between 1980 and 2000 with any level of educational preparation and in any setting or geographical location. The concept of this review is strategies and barriers for nurse retention.

 

Methods: The review will be conducted in accordance with JBI methodology for scoping reviews. Studies written in English and published after 2010 will be included. The databases to be searched include MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), Ovid Healthstar (Ovid), CINAHL (EBSCO), and PsycINFO (EBSCO). The search for unpublished studies will include MedNar (Mednar.com) and ProQuest Dissertations and Theses (ProQuest). Eligible studies will undergo data extraction by two independent reviewers using a tool created by the authors. Along with a narrative summary, results will be presented in diagrammatic or tabular form in a manner that aligns with the review objective and questions.

 

Article Content

Introduction

The US Bureau of Labor Statistics projects the need for 1.05 million new nurses by 2022.1 The shortage of nurses is not unique to the United States (US). The World Health Organization projects the need for 9.9 million nurses, midwives, and physicians globally by 2030.2 The Organization for Economic Cooperation and Development is composed of Canada, the United Kingdom (UK), the US, and Australia.3 This global organization reports a current nursing shortage and anticipates it will only worsen in the coming years.3

 

The nursing shortage is driven by the world's population living longer. By 2025, the growth of the aging population in the US will result in a 40% increase in demand for hospital beds.1 Europe has experienced a 10% increase in nurses during the previous 10 years, but even this is not sufficient to cover the needs of the aging population.2 The nursing profession must make strides in continuing to recruit people to enter the nursing profession and to retain them once they enter the workforce.

 

Researchers have used varying years to identify the millennial generation. Some have identified the millennial generation as beginning in 1980 or 1981 and ending between 1997 and 2002.4-11 In 2019, Pew Research Center delineated the millennial generation, also known as Generation (Gen) Y, as 1981 to 1996 and identified a new generation, Gen Z, as 1997 to the present.4 This new generation was created based on the change in cultural experiences and beliefs for this age group.4 For the purpose of this review, millennials will be defined as those born between 1980 and 2000, which currently includes members of both Gen Y (1980-1996) and Gen Z (1997-present).

 

The millennial generation is currently entering the workforce in record numbers.5 Millennials surpassed baby boomers (born 1946-1964) as the largest generation in 2016.12 Currently 30% of the US workforce is comprised of millennials.6 Newly graduated nurses, ages 23 through 26 years, have increased the number of full-time equivalent registered nurses (RNs) in this generation by 62% in the US.7 However, the percentage of these nurses leaving their current roles within one year is 30%, and within two years is 57%.8 Only 18% of millennial nurses expect to stay with their current employer, and 25% anticipate having six or more employers over their lifetime.7 This is a sharp contrast from previous generations2; baby boomers reported having, on average, three employers in their lifetime.7 The average job tenure for nurses 25 to 34 years of age is 2.8 years.6 Millennial nurses provide a challenge to nursing leaders as they make efforts to understand how to retain this group of nurses at the bedside.

 

There are many variables that affect a nurse's decision to remain in their current role. Nurses work in environments that require high levels of effort with little reward.12 The leading reasons cited for millennials leaving a work unit are poor practice environment; lack of support, orientation, and mentoring; and nursing being chosen as a "second best" or serendipitous career choice.9 Trending changes in commitment and satisfaction between the first and second years of practice lead to higher percentages of nurse graduates with turnover intentions.10 Leaders are challenged to maintain high job satisfaction and organizational commitment among nursing staff in the midst of a highly stressful work environment and a competitive job market.

 

Elevated levels of job satisfaction and organizational commitment are correlated with increased levels of retention.13 Key drivers for retention and engagement are the same for all nurses; however, the manner in which the organization engages their nursing workforce must be aimed at what is meaningful for each generation.11 Only 45% of millennials are engaged in their current work environments as compared to 52% of non-millennial nurses.6 Strategies for retention cannot be the same for every nurse, and generational differences must be incorporated into retention strategies. Job satisfaction is shown to be higher in older nurses; therefore, focus needs to be placed on millennial nurses.3

 

There are many benefits to focusing on retention of millennial nurses, such as the potential to reduce operating costs and enhance quality of nursing care.7 The cost of recruiting, orienting, and developing a newly hired nurse is estimated to be 0.75 to two times the departing nurse's salary.14 In the US, it costs roughly USD$65,000 for each new nurse to become competent in a patient care area.13 Lack of nurse retention is negatively related to operational performance and patient outcomes.15

 

The millennial generation has higher levels of burnout and emotional exhaustion when compared to other generations.16 Newly licensed nurses have high levels of psychological distress related to experiences in difficult nursing work environments, and this distress has been shown as a predictor to leave the profession.3 Because of the psychological distress experienced, 60% of millennials are consistently open to other job opportunities.6 If a millennial nurse stays in a position for three years, they are likely to remain loyal to the organization if they continue to remain fully engaged.11

 

Low nurse retention is an indication of a poor work environment.15 There is a multitude of research that discusses nurse retention and characteristics of healthy work environments, but little research has been conducted to identify specific retention strategies for millennial nurses.1,5,7,11,13,14 The objective of this scoping review is to explore the existing literature related to millennial nurse retention strategies and barriers; to examine and conceptually map the evidence; to extract any differences between nurse retention strategies and barriers for Gen Y and Gen Z; and to identify any gaps in the literature. Retaining this generation of nurses is crucial to meeting the increasing health care demands of the aging population. An initial database search of JBI Evidence-based Practice Database, Cochrane Database of Systematic Reviews, CINAHL, and PubMed in February 2020 revealed no current scoping or systematic reviews on this topic.

 

As health care becomes more cost-conscious, millennial nurse retention will be an avenue to help organizations remain financially sound. Retaining millennial nurses at the bedside decreases the cost of non-productive nursing staff during the orientation process, decreases organizational cost related to hospital-acquired conditions, and increases staff engagement.17 All of these components lead to a healthier work environment, decreased turnover, and improved financial performance.15 As hospitals and nursing leaders look towards the future, implementing retention strategies aimed at millennial nurses must be a focus. This generation provides the largest supply of nurses, but will become transient if not managed effectively and not fully engaged in their work environments.7

 

Millennial nurses entering the workforce have a multitude of choices when it comes to employment. The availability of choices may lead nurses to be transient with employment.7 Residency programs and mentorship programs are currently being used, but the aim of this scoping review is to take a complete look at the literature and identify strategies and barriers used globally to retain millennial nurses so that health care organizations can create work environments in which millennials nurses want to stay.13

 

Review questions

 

i. What strategies are being used to retain millennial nurses?

 

ii. What barriers to retaining millennial nurses have been identified?

 

iii. Are there differences in retention strategies and barriers for Gen Y and Gen Z?

 

Inclusion criteria

Participants

The review will consider studies that include retention strategies or barriers for RNs with any level of education born between the years 1980 and 2000. Because of the recent delineation of Gen Z, for the purpose of this review, those identified as millennial, Gen Y, or Gen Z will be included.

 

Concept

The core concept that will be examined by the scoping review is strategies and barriers for retention of nurses in the millennial generation. Retention is defined as nurses not leaving the organization for another position or not leaving the profession.18 Strategies are defined as interventions, programs, or concepts that are implemented to decrease millennial nurse turnover.11 Barriers are defined as challenges, obstacles, or concerns that inhibit, decrease, or encourage millennial nurses to not remain in the current work environment.13

 

Context

All settings and geographic locations will be considered for inclusion.

 

Types of sources

This review will consider both experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies, and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies, and analytical cross-sectional studies will be considered for inclusion. This review will also consider descriptive observational study designs including case series, individual case reports, and descriptive cross-sectional studies for inclusion.

 

Qualitative studies will also be considered that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, qualitative description, action research, and feminist research.

 

Text and opinion papers will also be considered for inclusion in the scoping review.

 

Methods

The proposed scoping review will be conducted in accordance with JBI methodology.19

 

Search strategy

The search strategy will aim to find both published and unpublished studies. An initial limited search of MEDLINE (PubMed) and CINAHL (EBSCO) was undertaken followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe article. This informed the development of a search strategy that will be tailored for each information source. A proposed search strategy for CINAHL is detailed in Appendix I. The reference lists of all studies selected will be screened for additional studies.

 

The databases to be searched include MEDLINE (PubMed), CINAHL (EBSCO), Embase (Elsevier), Scopus (Elsevier), Ovid Healthstar (Ovid), and PsycINFO (EBSCO).

 

The search for unpublished studies will include MedNar (Mednar.com) and ProQuest Dissertations and Theses (ProQuest).

 

Studies published in English since 2010 will be included. The oldest of the millennial nurses are in their late 30s to early 40s. The aim of this scoping review is to identify the most current research on millennial nurses entering the workforce, thus the length of time since an article was published will be important for gaining the most recent information. If research includes multiple generations, only results from articles that clearly delineate results between each generation will be used.

 

Study selection

Following the search, all identified citations will be collated and uploaded into EndNote X9 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant studies will be retrieved in full and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full-text studies will be recorded and reported in the scoping review. Any disagreements that arise between the reviewers at each stage of the study selection process will be resolved through discussion or with a third reviewer. The results of the search will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses for scoping reviews (PRISMA-ScR) flow diagram.20

 

Data extraction

Data will be extracted from papers included in the scoping review by two independent reviewers using the draft data extraction tool in Appendix II. The data extracted will include specific details about the population, concept, context, and study methods of significance to the scoping review question and specific objectives. Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of papers will be contacted to request missing or additional data where required. The draft data extraction tool will be modified and revised as necessary during the process of extracting data from each included study. Modifications will be detailed in the full scoping review report.

 

Data analysis and presentation

The extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the three questions and objective of this scoping review. Figures, tables, and charts will be used when appropriate. The tables and charts will report on the following: publication date, authors, country of origin, study population, generation/birth years identified, aim of the study, context and setting, study methods, retention strategies identified, barriers identified, and generational differences identified (between Gen Y and Gen Z). A narrative summary will accompany the tabulated and/or charted results and will be organized as a response to each of the three review questions.

 

Acknowledgments

This scoping review will contribute toward a Doctor of Nursing Practice (DNP) degree for AM.

 

Appendix I: Search strategy

CINAHL (EBSCO)

Search conducted July 2020

 

Appendix II: Data extraction tool

References

 

1. Bugajski A, Lengerich A, Marchese M, Hall B, Yackzan S, Davies C, et al. The importance of factors related to nurse retention: using the Baptist Health Nurse Retention Questionnaire, Part 2. J Nurs Adm 2017; 47 (6):308-312. [Context Link]

 

2. World Health Organization. Health workforce: data and statistics [internet]. [cited 2019 Dec 31]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/health-workforce. [Context Link]

 

3. Currie EJ, Hill RAC. What are the reasons for high turnover in nursing? A discussion of presumed causal factors and remedies. Int J Nurs Stud 2012; 49 (9):1180-1189. [Context Link]

 

4. Dimock M. Defining generations: where millennials end and deneration Z begins [internet]. Pews Research; 2019 [cited 2020 Jun 19]. Available from https://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-gener. [Context Link]

 

5. Chung S. Moving up millennials to leadership roles. Am Nurs Today 2012; 11 (12):9. [Context Link]

 

6. O'Hara MA, Burke D, Ditomassi M, Palan Lopez R. Assessment of millennial nurses' job satisfaction and professional practice environment. J Nurs Adm 2019; 49 (9):411-417. [Context Link]

 

7. Andrews DR. Expectations of millennial nurse graduates transitioning into practice. Nurs Adm Q 2013; 37 (2):152-159. [Context Link]

 

8. Ulep K. The nurse leader's pivotal role in retaining millennial nurses. J Nurs Adm 2018; 48 (12):604-608. [Context Link]

 

9. Flinkman M, Salantera S. Early career experiences and perceptions-a qualitative exploration of the turnover of young registered nurses and intention to leave the nursing profession in Finland. J Nurs Manag 2015; 23:1050-1057. [Context Link]

 

10. Tyndall DE, Scott ES, Jones LR, Cook KJ. Changing new graduate nurse profiles and retention recommendations for nurse leaders. J Nurs Adm 2019; 49 (2):93-98. [Context Link]

 

11. Koppel J, Deline M, Virkstis K. The case for focusing on millennial retention. J Nurs Adm 2017; 47 (7-8):361-363. [Context Link]

 

12. Choi SP-P, Pang SM-C, Cheung K, Wong TK-S. Stabilizing and destabilizing forces in the nursing work environment: a qualitative study on turnover intention. Int J Nurs Stud 2011; 48 (10):1290-1301. [Context Link]

 

13. Wieck KL, Dols J, Landrum P. Retention priorities for the intergenerational nurse workforce. Nurs Forum 2010; 45 (1):7-17. [Context Link]

 

14. Brunetto Y, Farr-Wharton R, Shacklock K. Communication, training, well-being, and commitment across nurse generations. Nurs Outlook 2012; 60 (1):7-15. [Context Link]

 

15. Kovner CT, Brewer CS, Fatehi F, Jun J. What does nurse turnover rate mean and what is the rate? Policy Polit Nurs Pract 2014; 15 (3-4):64-71. [Context Link]

 

16. Keepnews DM, Brewer CS, Kovner CT, Shin JH. Generational differences among newly licensed registered nurses. Nurs Outlook 2010; 58 (3):155-163. [Context Link]

 

17. Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs 2010; 20 (1-2):23-33. [Context Link]

 

18. 2019 magnet application manual. Silver Spring, MD: American Nurses Credentialing Centre; 2017. [Context Link]

 

19. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: scoping reviews. In: Aromataris E, Munn Z, editors. JBI Reviewer's Manual [internet]. Adelaide: JBI; 2020 [cited 2020 Jun 19]. Available from: https://reviewersmanual.joannabriggs.org/[Context Link]

 

20. Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. The PRISMA-ScR Statement. Ann Intern Med 2018; 169 (7):467-473. [Context Link]