Nurse retention remains a problem that can affect the quality of patient care. In a survey of 3000 hospitals conducted in January 2021, NSI Nursing Solutions, Inc, found that the average bedside nurse turnover rate was 15.9%.1 Some of this turnover may be related to the COVID-19 pandemic, but the trend among new nurses is especially troubling. According to the NSI survey, 23.9% of all registered nurses (RNs) with less than 1 year of experience leave within a year. This accounts for 24.1% of all RN separations; nurses with less than 2 years of service account for 43% of all RN turnovers in 2021. The average cost of turnover for a bedside RN is $44400; the average hospital loses $4.9 million per year due to turnover. NSI reports that 94.8% of the hospitals in their survey view retention as a "key strategic imperative." To meet this imperative, the root cause of turnover, especially in nurses with less than 2 years of tenure, must be uncovered. Understanding these new nurses is key. Generationally, new nurses are typically late millennials or Generation Z. Millennials are defined as those born between 1981 and 1996; Generation Z are those born after 1996.
THE NEW RN
In their study of millennial nurses' job satisfaction, O'Hara et al2 found that millennial nurses tend to value commitment, compensation, and collaboration differently than other generational cohorts do. Millennials want to work in flexible, motivating, and safe environments. They value collaborative work settings, prefer coaches to bosses, and want autonomy and career development. Millennials tend to expect open communication with ongoing conversations about progress. They are more likely to experience burnout and stress in their work setting.
Current traditional college graduates are likely to be members of Generation Z. This group grew up with cell phones and do not remember a time without the internet. Because many of their parents were affected by the economic crash of 2008, Generation Z new graduates tend to be obsessed with safety and ensuring their economic security.3 Command and control do not work for them; they value sharing of the big picture and transparency about motives and outcomes.
There are general characteristics of late millennials and Generation Z that affect the workforce. This cohort often had "helicopter" parents who made sure that they received trophies simply for participating in an activity.4 Many are "fragile perfects," who know how to succeed but do not know how to recover from failure.5 Another issue for this cohort is impatience. Same-day delivery and curbside pickup, as well as electronic communication, have conditioned them to expect instant gratification.3 However, things such as job satisfaction and meaningful relationships often require time to develop. New graduates want to make an impact in their jobs, but many are not prepared for the required time commitment and often leave the job in 9 to 12 months because they did not have impact as they had hoped. They crave recognition from bosses, mentors, and coworkers that they are doing a good job.4 Work-life balance is important to them, and a job may not be their prime motivator. Twenge3 reports that many Generation Z graduates do not expect deep satisfaction from their work; they strive to find a job "that they don't hate." This lack of fulfillment is often characterized by a lack of coping skills, which may make them more prone to depression and anxiety. Some suggest that organizations should reinvent themselves to meet the demands of the millennial or Generation Z workforce. The work of Duckworth5 would suggest that these new graduates need to become gritty.
DEVELOPING GRIT
Duckworth5 looked at the characteristics of individuals at the US Military Academy at West Point, which were associated with surviving the grueling summer experience known as "Beast Barracks." Neither intelligence nor physical fitness nor leadership ability was a good indicator of who would "survive Beast." Duckworth determined that grit, the combination of passion and perseverance, was the best predictor of success. Individuals who have grit know what they want, have a relentless desire to improve, and, even when things are boring, frustrating, or painful, would not dream of giving up. Grit is more than talent or skill; it requires ongoing effort that must be sustained over time.
How does an individual become gritty? Duckworth5 suggests that grit can grow from the inside out or outside in. Growing grit from the inside out is time-consuming and takes years of deliberate practice. In some ways, the easiest way to grow grit is from the outside in. As Duckworth says, "If you want to be grittier, find a gritty culture and join it. If you're a leader and you want the people in your organization to be grittier, create a gritty culture."5(p245) How does the leader create the gritty culture?
According to Duckworth,5 a distinct culture exists when a group of people are in consensus about how things are done and why. The clinical nurse leader (CNL) role was created, in part, to assume guardianship for the nursing profession. One way this guardianship can be demonstrated is in the CNL's involvement in the development of a gritty unit culture that promotes the well-being of both patients and nurses. In a gritty unit, new nurses are exposed to high standards of performance and responsibility and they aspire to meet the team's norms and expectations.
Gritty cultures require relentless communication.5 This relentless communication must be respectful, self-esteem building, and constructive. The unit has a culture of communication; mistakes and problems are seen as opportunities to get better rather than reasons to quit. The CNL strives to understand how the person can be supported to stay the course. Gritty cultures know and live their core values. CNLs should be able to clearly articulate the purpose of their unit so that all who are on the unit know and promote the values that make the unit a success. Focusing on teamwork is key, as teamwork is a core value that millennials rate highly.2
Gritty cultures are respectful. Unfortunately, incivility and bullying are still a problem in nursing. Cultures that allow incivility need to be changed and require a leader who will insist that no one looks the other way when someone attempts to bully or denigrate new nurses. On a gritty unit, nurses are treated with unconditional respect. If graduates fall short of meeting the unit's high standards, there are people who will work with them to achieve their goals. Providing new nurses with appropriately demanding challenges coupled with consistent support is the key. Millennials want coaches not bosses; supportive leadership is a fundamental driver of millennial work satisfaction.2,4 Helping another person become gritty also benefits those who help by allowing them to renew their own grit. Millennials and Generation Z graduates want to make an impact, so helping them develop an early sense of accomplishment is critical.
Grit goes hand in hand with life satisfaction.5 The grittier the person, the more emotional well-being they have. Developing gritty cultures in our clinical areas may be a solution to the nurse retention issue and can promote quality patient care. The CNL can be a key determinant of a culture that makes new nurses want to "stick" rather than flee.
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