Artcle: Generations in Nursing

How have multiple generations in the nursing workforce affected social processes in organisations and why is this important for exercising leadership?

Introduction

There’s a saying that goes ‘nurses eat their young’ which refers to the bullying of new nurses and the lack of compassion towards those who are newly entering the workforce (Reinbeck & Fitzsimons, 2014). Some may find this appalling, but the question here is, is this a sad truth that is to be accepted or can it be changed? The nursing workforce comprises of various distinctive groups of people with different background, genders, ethnicity, race, religion, nationality, culture and beliefs. In this 21^st century, the working dynamics in nursing is unique and complex such that a more proficient leadership and management approach is required to understand and motivate these nurses towards an efficient and effective healthcare service. This paper is going to argue and compare the works of various authors by providing examples related to the nursing workforce. As a whole, this effort will explain the effects of multiple generations on the social process in the nursing organization and its significance in practicing leadership. 

Social Process and the effects of Generational Diversity

What is a social process? According to Pujari (1998) social process refers to the ways of how groups or a person communicates and constructs social relationships. In an independent study about multigenerational challenges, Dickerson (2010) clarifies that the development of views, values and ultimately behaviour of every generation are shaped by events that influenced its growth. The advent of world wars, the hippie movement

and technology are all significant events that mark its footprint in each generation. However, not all individual born in a certain generation behave in the same way as others in their age group because it depends whether members are born in the early or late stage of their cohort (McNeill, 2012). Hence, creating a harmonious working environment is a challenge for nursing leaders. In nursing context, the social process in the nursing workforce constantly varies as new graduate nurses replace old nurses who retire or leave the organization. As the saying goes, ‘Out with the old, in with the new’. Therefore, the cycle of generations and the existing gaps between them have a significant impact on the social process of an organization. There are four generations in the nursing workforce but Generation X and the Baby boomers are the two predominant groups (Leiter, Jackson & Shaughnessy, 2009). Generation Y mostly consists of new graduate nurses that enter the workforce whilst the veterans or traditionalist are the oldest generation. Therefore, in a nursing perspective, how do such differences impact the pattern of interaction in establishing social relationships among nurses?

Changes in Decision-making

The first effect of multiple generations in nursing is on decision-making. Veterans or the traditionalist born between 1922 to1943, ranging about 60 to 90 years old are very knowledgeable about organizational changes and antiquity, extremely experienced, have good personal relationships and knows how to work hard (McNeill, 2012). They are used to a chain of command at the time they grew up unlike the millennial that are expected to participate in group discussions. This can be related to Henderson (1964) who described her student nurse experience as an authoritarian form of nursing which was what veterans were facing at that time. Generation Y or the millennial born between 1980 to 2000, are determined to make changes, technology savvy and adapt well in group works (McNeill, 2012). In another paper written by Price, McGillis Hall, Angus and Peter (2013) about reasons for millennial nurses to choose nursing as a career, also describes the same characteristics and found that they seek meaning in their career as well. The millennial are interested in activities that promote social interaction (Bhana, 2014). In other words, veterans are used to a one way communication in contrast to generation Y who anticipates a two way communication. Consequently, without shared experiences, a multigenerational organization could promote conflict and the distinctions between each generation affects group unity (Jobe, 2014).

However, Mary Parker Follett depicts that conflict brings about constructive ways in achieving organizational goals (Pindur, Rogers & Kim, 1995). Hence, as a nurse leader, he or she must be knowledgeable of what motivates and demotivates a multigenerational team that helps to prevent team dysfunction (Douglas, Howell, Nelson, Pilkington & Salinas, 2015). In other words, nurse leaders need to be able to influence the older nurses to actively take part in voicing out what they feel, as their opinions hold great value amounting from their years of expertise. Besides that leadership is the art of motivating people to attain a shared goal (Clark, 2015). In other words, practising transformational leadership style may contribute to healthy working relationships. As Cutcliffe and Wieck (2008, p. 499) cites the work of Sofarelli and Brown (1998) and Sullivan and Decker (2001), they contend that transformational leadership aims on change and encourages nurses to hold an influential and participatory role in policy formation and feedback. Moreover, Sellgren, Ekvall and Tomson (2006) sees this leadership style as a union of employee orientated and change oriented styles. That is to say, the capability to engage others in social interaction and social expressiveness is essential for leaders (Riggio & Reichard, 2008). Exercising this leadership style guides nurse leaders to be aware and consciously be informed of any problems or dissatisfactions faced by nurses in their daily patient care. Subsequently, nurse leaders may collaborate with top management in solving the issues confronted by nurses which may lead to staff retention as nurses on the floor are made to feel that their voices are heard and is important. Strategies focused on retaining experienced nurses are essential in maintaining nursing workforce now (Sparks, 2011). In a study by Aiken, Sloane, Bruyneel, Van dan Heede and Sermeus (2013), one of the factors contributing to job dissatisfaction in most of the nurses, close to every twelve countries studied in the research is the insufficient opportunities to take part in hospital decision makings. In fact, well rounded clinical governance in the healthcare system is required to ensure holistic participation between healthcare professionals and top managements. Executives and boards should improve their method of data reporting and management, while building ways to promote decision making groups in every level to make use and share information (Braithwaite & Travaglia, 2008) for  better patient care and safety.

The need for flexibility

The second effect of multiple generations in the workforce is the need for flexibility. Dickerson (2010) says that generation X was born between 1965 to 1980 and is focused towards a work-life balance and seeks opportunity for growth. Another latest qualitative research paper by Keys (2014) also reinstates that generation X strive for professional success in terms of additional education and personal fulfilment in terms of spending

time with family. In another article, the top three reasons to plan for an early retirement among older nurses are personal reasons like wanting to spend time with family and the need for more leisure time (Myer & Amendolair, 2014). In addition, Leiter et al., (2009) described the incompatibility between values and work environment among generation X nurses that lead to their intention to leave and experience burnout. In a recent study by Jobe (2014) found that leisure was important to generation X and the Millenials. Furthermore, Maslach et al. (2001 as cited in Leiter et al. 2009, p. 102) found that the chronic incongruence in essential areas of work life resulted in burnout in both generation X and baby boomers. In other words, every age group uphold a distinct social and work values (Cenamo & Gardner, 2008, Angeline, 2011 as cited in Robson & Robson, 2014, p. 67). How then do we bridge the gaps?

 It’s necessary that nurse leaders identify, value and support generational variation in nursing to reach a common ground (Reinbeck & Fitzsimons, 2014). Leiter et al., (2009, p. 102) cites the work of Butterworth et al., (1999), Grecco et al., (2005) who stated that burnouts is also found to be related to leadership styles in nursing management and further cites Kim et al., (2005) who argued that procedure and policies that assists empowerment among nurses also relates to burnouts. In other words, a leader should possess what it’s called social intelligence defined by early researches as the capability to comprehend and manage people (Thorndike & Stein, 1937 as cited in Crowne, 2012, p. 151). Specifically, as argued by Riggio and Reichard (2008, p. 175), both social and emotional sensitivity is required to comprehend what each worker is experiencing and feeling. However, given that a nurse manager understands their employees well, they are still not in the right position to make changes. In the study by Shirey, McDaniel, Ebright, Fisher and Doebbbeling, (2010, p. 84), they found that around two thirds of nurse managers proposed problems relating to organizational rigidity, interpersonal disagreement, changing ground rule requirements, several hospital initiative going on

concurrently and  system inadequacies as elements contributing to stress. Yes, the intricacy of healthcare reinstates the power held by healthcare providers to shape health care policy but whether or not these policies are implemented by governments in their respective countries are uncontrollable because the legal authority to decide for the people entirely lies only in the hands of the ruling government (Blank & Burau, 2007). In a way, Max Webber’s introduction to bureaucratic management (Pindur et al., 2012) is exercised in the healthcare system. Although the complexity of the healthcare leads to the need for a systematic management system, managing from a top down hierarchy as has an impact on the overall functioning of healthcare. It is somewhat relatable to the proposition of Marx and Engels who described that the ideas of the ruling class were the ruling ideas and are implemented by the ruling class to exert power (Mantzoukas, 2007). Moreover, around half of the nurse managers proposed that they know what to do but they lack power to get it done (Shirey et al., 2010). In a study by Newman and Lawler (2009), they found that nurse managers reported a lowered level of control over their work due to the increasing politicization and bureaucratization. This calls to say that there is no association between the higher authoritative administrators and their on floor staff. Comparatively, Robson and Robson (2014) argued that a solitude development of policy either internally or externally by an institution is inadequate. Consequently, further studies and research are needed where a bottom up system and clinical governance could be more effective in dealing with the complexity of healthcare. As Braithwaite and Travaglia (2008) contends that although clinical governance is new and is becoming a more accepted approach in improving safety and quality of health care service, the signs are promising.      

Skills Interdependency

The third effect of multigenerational working environment is skills interdependency. ‘‘Sixty years ago, young nurses encountering a patient with an unusual diagnosis relied on their more senior colleagues for instruction and advice’’ (McNeill, 2012, p. 12). With the emergence of technological advancement, it’s the other way around. Generation Y are very computer literate and congenial with technology because electronics have always been youngsters lifestyle (Dickerson, 2010). Rather than younger people turning to the older nurses for advice, older nurses depend on younger colleagues in using the computer for everything (McNeill, 2012). Besides that, generation X evolved around technology that weren’t readily available for baby boomers till adulthood (Leiter et al., 2009). Therefore, nurse leaders need to know how to incorporate the various skills that a multigenerational team possess as Bill Gates says, ‘technology is just a tool. In terms of getting the kids

working together and motivating them, the teacher is the most important’. Robson and Robson (2014, p. 67) cites the work of Disch (2009) who contended that reinforcing nurse manager’s need to comprehend and practically respond to the generational diversity in nursing is important in a policy formation. On the other hand, Reinbeck and Fitzsimons (2014) found that reverse mentoring is likely to succeed in constructing a leadership pipeline, encouraging intergenerational relationships, promoting diversity initiatives and propelling innovation. The paper explains the process of reverse mentoring as pairing a younger staff with an experienced staff to share the younger employee’s expertise. In a study to retain generation Y peri-operative nurses, Sherman (2015) believes that generation Y make excellent reverse mentors for older perioperative nurses in a team because of their love for technology.  Although there has been limited research on its implementation, this method seems promising. Based on the study, generation Y members feels valued in this new mentoring role (Reinbeck & Fitzsimmons, 2014). Basically, this relates to Abraham Maslow’s hierarchy of needs, specifically the social needs, as he believed that people are motivated by specific needs (Pindur et al., 1995). When certain needs are met, the individual can then proceed to attain other needs to achieve self-actualization. This creates a team like environment and it is probable that millennial expect to be appreciated as team members for their team involvement instead of being focused on individual efforts (Andrews, 2013). Hence, nurse leaders should tap on creating teamwork among multigenerational nursing workforce. Furthermore, teamwork at a high level could lead to a greater job satisfaction (Kalisch & Begeny, 2005). In the study regarding the expectations of graduate nurses moving into practice also found that teamwork maybe crucial to millennial job satisfaction (Andrews, 2013).

Job Satisfaction

The fourth implication of different generations in the workforce is job satisfaction. Lu, While and Louise Barriball (2005) explains that job satisfaction depends on the individual’s expectation of what the job will provide rather than just depending on the nature of the job. Andrews (2013) found that failure to meet expectations of newly graduate nurses and its relative impact are probably the fuel of turnover. Moreover, what

proved to be difficult to nurse leaders is the expectation of accommodation by generation Y nurses (Sherman, 2015). They are in the group of what Benner (1982) describes as novices because they are starters with no experience to guide them and as a way to provide an entry to them, they are taught about objective attributes. In other words, these new nurses had to rely on the senior nurses for guidance and to do that, a good mutual relationship has to be built. In this situation, the relationship between nurse leaders and their employees should be strong for them to recognise any existing problems, especially bullying. A qualitative study on work organization and health among workers in general carried out by MacDermid, Geldart, Williams, Westmorland, Lin and Shanon (2008) pointed out that young workers think that older adults disrespects them and pushes them around because they are powerless in the workplace. Besides that, in another study about what makes a nurse faculty in academic position remained employed,

Tourangeau, Wong, Saari and Patterson (2014) reported that generation Y felt disrespected by their workmates because of their youth. In addition, Andrews (2013) revealed that almost 90% of new graduates reported experiences of incivility and the failure in identifying them may contribute to turnovers. Hence, a leader should be emotionally sensitive to identify what satisfies or dissatisfies an employee. Frederick Herzberg’s motivation-hygiene theory relates to job satisfaction (Pindur 2012). The ability to decipher the emotional and non-verbal messages of others defines emotional sensitivity (Riggio & Reichard, 2008). Additionally, a combination of personal and analytical skills is required to set an aim and pave a strategy to reach a common goal (Clark, 2015). The amalgamation of these characteristics makes an exceptional leader that contributes to job satisfaction among nurses subsequently encouraging staff retention for a longer period of time.

Conclusion

As time goes by, nursing workforce is constantly expanding with nurses of distinct age, nationality, education level, race, marital status, work experience, attitudes, beliefs and culture entering the workforce. Relatively, this can be due to the shortage of nurses that leads to the re-entry of older nurses into workforce, increase in nurse immigration from around the world and the introduction of new retirement plans for the retention of older nurses. Hence, to manage this diversity, a good leader is needed. Clark (2015) says that anyone with distinct qualities can make as leaders but their own personal sets of weaknesses and capabilities are what it depends on. Therefore, choosing capable nurse leaders who are aware of their own leadership profile, tasks and ability are crucial given that they are front liners in healthcare service. However, they aren’t the only one who holds responsibility for this challenging nursing framework. Additionally, the cooperation, understanding and support of the healthcare system as a whole, be it the government, private institutions, or the higher management of the hospital, are essential in creating a safe and harmonious working environment for employees. As Helen Keller once said, ‘alone we can do so little; together we can do so much’. It follows with more research, theories and ideas that are needed to be made to better understand different generations at work. As we work towards this goal, the nursing profession should push any biasedness, discrimination and differences aside as we learn to be receptive and embrace the rich diversity that a multigenerational workforce brings into nursing.

By,

Jessica John Posko

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