Knowing Generation Y: a new generation of nurses in practice.

nursing development

Knowing Generation Y: a new generation of nurses in practice Stephanie M Chung and Virginia Fitzsimons

H

© 2013 MA Healthcare Ltd

ealthcare organisations and nursing worldwide are concerned with retention of staff, as it directly affects the quality of patient care. Replacing and inducting new staff is costly, time-consuming and affects both organisational success and growth. Keeping new staff in roles to replace an ageing nursing workforce is critical. Generation Y nurses are the current and up-and-coming generation that will fill nursing posts. This cohort is the latest in the four generations of nurses working side-by-side. Those born close to the turn of the 21st century are known by many names, including Generation Y, the Millennials, Echo Boomers, Linked Generation, Era of the Child, Generation Net, Nexters, the Younger Portion of Gen X, the Plugged In Generation, the Second Baby Boom, Boomlets, the Internet Generation, I Generation and Generation WHY (Jamieson, 2009). The most commonly used nickname is Generation Y, classified as those born between 1980 and 2000, the successors to Generation X. The term ‘Generation Y’ was coined by Advertising Age magazine in Chicago, USA, in 1993. There are currently 81 million individuals in the Generation Y cohort, making them the second-largest, and possibly most influential, cohort after World War II (Manion, 2009). Generation Y nurses are entering the healthcare and nursing environment and will continue to fill the workplace for years to come. But they are more transient than previous generations. Retention of Generation Y nurses has been a concern, as organisations are experiencing high turnover (the number of new staff entering, then leaving, an organisation) of this group. ‘Today’s healthcare organisation, struggling with matching resources to needs, cannot afford the high cost of generational enmity’ (Manion, 2009). Globally, many countries are having difficulty retaining nursing staff and this worries enterprises due to the impact it will have on patient care and operating costs. Many studies have tried to find the ideal answer to Generation Y’s wants and needs in the workplace (Lavoie-Tremblay et al, 2010a; Wieck et al, 2010; Cogin 2012). Reviewing these concepts will lead to less turnover and address the issues of quality care and cost saving. Multiple qualitative focus-group studies were reviewed, which displayed recurrent themes and suggestions for

Stephanie M. Chung is an alumna of Kean University, where she is now a professor, and Virginia Fitzsimons is Professor and Executive Director, School of Nursing, Kean University, New Jersey, USA Accepted for publication: October 2013

British Journal of Nursing, 2013, Vol 22, No 20

Abstract

Generation Y is commonly defined as those people born between 1980 and 2000, now aged in their 20s and 30s. Their grandparents experienced post-World War II reconstruction, their parents the economic boom of the 1980s. There are currently 81 million individuals in the Generation Y cohort in the USA, making it the second-largest, and possibly most influential, cohort since World War II (Manion, 2009). Members of Generation Y are diverse, technologically advanced and vocal about their opinions. They tend to resist traditional hierarchy, want recognition/reward for achievements and distrust institutions. Knowing these characteristics is useful for nurse managers, preceptors and team members working with members of Generation Y. Studies have proven that Generation Y is challenging the nursing workforce through rapid turnover (Cogin, 2012). This article explores a theoretical model that predicts retention and/or turnover of nurses in light of Generation Y behaviours and motivators—for example, moving from agency to agency rather than devoting many years to a single practice. Further research is needed to find out whether these behaviours and motivators are unique to Generation Y alone. Key words: Generation Y ■ Behaviour ■ Motivator ■ Turnover ■ Retention retention and understanding of the motivations for this new generation. A combination of the findings can lead to a clearer vision of what motivates Generation Y, how to foster workplace commitment and even decrease turnover. Recent international literature in human resources management (Cogin, 2012) states there is a ‘talent squeeze’. It elaborates: ‘[the] economic turbulence of the past few years has created a talent paradox given that in a period of stubbornly high unemployment, employers still face challenges filling technical and skilled jobs… [for example] workforces in China, the US, and most of Europe are ageing[,] these changes are putting a strain on companies and their leadership to identify and implement effective rewards programmes as each generation is marked with distinct values and expectations… This is the first time in history where four generations of people can be seen in the same workforce, the challenge of designing rewards programmes that motivate, attract and retain all employees is significant’ (Deloitte, 2013)

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Identifying and recognising these four challenges/ implications keeps organisations and nurses abreast of current workplace developments and encourages a cultural view of worldwide trends in nursing.

It is documented that a global imbalance exists for the supply/demand of nurses: ‘for example, the number of countries sending international nurse recruits to the United Kingdom has increased from 71 in 1990 to 95 in 2001; 43% of working international nurses surveyed in London report they are considering relocating to another country, in many cases to the United States’ (Kingma, 2007). The loss of established nurses is undesirable. Generation Y nurses might well be those filling the 40 000 empty posts. The current global nursing shortage largely affects healthcare delivery. Recruitment and retention efforts can never be powerful enough to fill the existing gaps if that gap is widened by an exodus from the nursing profession. According to WHO, nurses comprise 40–50% of the global healthcare workforce (Stanley, 2010). With all generations of nurses experiencing high job dissatisfaction, increasing burnout and alarming turnover rates, the time to act is now. Generation Y is the current focus of recruitment and retention concerns world- and industry-wide. If an attempt is not made to understand their workplace motivations, the bright future and potential of this generation will be dimmed. WHO has taken a stance in the matter, declaring that ‘retention of nurses in the healthcare workforce is vital in order to avoid undesirable effects for consumers of healthcare services’ (Jamieson, 2009). They have also suggested that 57 countries face critical workforce shortages severe enough to affect the delivery of essential nursing care (Stanley, 2010). ‘Organisation for Economic Co-operation and Development (OECD) countries such as Canada, the United Kingdom, the United States, and Australia are all experiencing turbulent nursing labour markets characterised by extreme staff shortages and high levels of turnover’ (Currie and Hill, 2012). The Royal College of Nursing (RCN, 2013) recently released its report, Frontline First: Nursing on red alert, on the importance of staff retention, safety and education. This critique strives to explain the intrinsic and extrinsic motivators of Generation Y and the influence of those motivators on retention. It was broadly found that direct management has the largest effect on nurses and their motivation towards workplace dedication. However, this article is not solely directed towards leadership: the intention is to provide an informative review for organisational hierarchies, various career disciplines and nurses, both of this generational cohort and those working alongside them, who often have similar work-life wants and needs.

The future of nursing

Literature search strategies

Although many studies have tried to find the ideal answer to Generation Y’s requests in the workplace, a review of the literature has shown that no one factor can be extracted as the perfect answer. Nevertheless, recurrent themes and expert suggestions for retention are known (Currie and Carr Hill, 2012). This review serves to recognise and use ‘generationalspecific interventions and approaches’ to prevent turnover, as outlined by The International Centre for Human Resources in Nursing (2009).

This international literature review was limited to 2008–2013.

Creating a workplace culture that engages all workers and results in a high retention rate

Remaining adaptive to current circumstances and responding with flexibility in approaches in practices

Effectively dealing with the culture clash and conflict that can occur between generations

Recognising and using generational-specific interventions and approaches

Figure 1. The International Centre for Human Resources in Nursing (Manion, 2009)

In general, global organisations are experiencing difficulty attracting and retaining talented workers, particularly those in Generation Y, and struggling to compete for increasingly scant human resources (Cogin, 2012).The influx in employed nurses could be considered a gift to the nursing profession, but one that requires sensitive handling. Workplace culture may need to consider changes in an effort to attract talented professionals and retain them to meet the increasing needs of an ageing population. The International Centre for Human Resources in Nursing has identified four main ‘challenges and implications of managing a multi-generational workforce’: ‘Creating a workplace culture that engages all workers and results in high retention rate; Remaining adaptive to current circumstances and responding with flexibility in approaches in practices; Effectively dealing with the culture clash and conflict that can occur between generations; and Recognising and using generational-specific interventions and approaches’ (Manion, 2009) (Figure 1)

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The UK on ‘red alert’ ‘The Royal College of Nursing (RCN) has been examining the impact of financial pressures on the National Health Service (NHS) since 2010 [in April 2013 it released its first report] following the publication of Robert Francis QC’s findings into the scandal at Stafford Hospital (Francis,


CHALLENGES AND IMPLICATIONS OF MANAGING A MULTI-GENERATIONAL WORKFORCE

Seriousness of the impact on nursing: trends and observations



nursing development 2013). His report found that care failings—and even hundreds of excess deaths—were partly caused by cuts to nursing staff and a dilution of skill mix. Although there were many warning signs that something was wrong, no-one put together the pieces of the jigsaw to see the whole picture until it was too late. RCN believes that there are now red lights flashing across the UK, warning that they are heading for a nursing shortage that could have serious implications for health services and patients’ (RCN, 2013)


Generation Y nurses are the students and nurses in practice who will lead the changes necessary. According to the RCN (2013), the warning lights are: ■■ Warning light 1: nursing posts cut ■■ Warning light 2: student places cut ■■ Warning light 3: the ageing nursing workforce. ‘Overall, 47% of nurses in England, Northern Ireland and Scotland are over 45’ ■■ Warning light 4: the impact of nursing shortages ■■ Warning light 5: demand. ‘The predicted shortfall in nursing staff comes at a time of rising demand for nursing care’ ■■ Warning light 6: a system under pressure. ‘The decreasing supply of nursing staff, coupled with rising demands for care, has led to increased pressure on acute services in recent years throughout the UK. All these trends have meant that NHS nursing staff are feeling increasingly under pressure’ The red lights identified by the RCN mirror the issues that Generation Y nurses are experiencing worldwide and show why attention should be paid to the motivators identified within this cohort. The future of nursing practice and care in the UK depends on addressing and rectifying these warning signs. This young generation of nurses will lead the profession and provide care for an ageing population, which is why they must be retained. Predictive modelling research done in 2011 examined ‘the future size of the workforce in England; the two worstcase scenarios showed what would happen if student places decreased and more people left the workforce or retired. Under these conditions, the study showed a decrease of between 23% and 28% of the qualified nursing workforce over a ten-year period, a loss of between 81 000 and 99 000 nurses. [This academic modelling shows] the huge impact of decreasing the number of people entering the workforce and increasing the number leaving’ (RCN, 2013). The RCN recommends that we ‘recognise the problem and act now to prevent a nursing shortage’ and goes on: ‘we have identified eight recommendations that governments and healthcare organisations across the UK should follow’ (RCN, 2013): ■■ Recommendation 1: Improve nurse workforce planning. ‘With the ever-increasing demand for health care, it is naive to believe we will need fewer nurses in the future. Instead of simply decreasing the number of pre-registration student places each year—choking off the supply line into


the profession—we need to move to a more evidence-based and robust, long-term workforce planning process that more accurately assesses future demand and supply’ (RCN, 2013) ■■ Recommendation

2: Protect frontline nursing from workforce cuts ■■ Recommendation 3: Ensure nurse staffing levels are safe everywhere ■■ Recommendation 4: Ensure boards maintain and review up-to-date information and key indicators relating to the workforce ■■ Recommendation 5: Make workforce planning multidisciplinary and closely aligned with service planning ■■ Recommendation 6: Invest in advanced nurse roles and training ■■ Recommendation 7: Invest in the health and wellbeing of nursing staff: ‘With the nursing workforce set to decrease, healthcare organisations must do what they can to retain the staff they have by making sure that they are supported at work. If nurses are overworked and stressed it can lead to burnout, and the loss of experienced and skilled team members. The Boorman Review showed that staff health and wellbeing, and patient outcomes, are linked (Boorman et al, 2009) ■■ Recommendation

8: Protect funding for nurse training and

development ‘Nurses need support and training throughout their careers if they are to meet the challenges of an ageing population and if patients are to properly benefit from new technology and innovation. Continual professional development is not an optional extra, but essential for maintaining quality patient care’ (RCN, 2013)

Theoretical considerations Theoretical models are needed to guide studies and provide framework for predicting human behaviour. In the UK, ‘the Roper, Logan and Tierney model is a model of nursing care based upon activities of living (ALs) that guides nursing practice’ (Wikipedia, 2013). Use of a theoretical model for management is also important to guide nursing leadership practice and assist with retention of nurses.

Siegrist’s Effort-Reward Imbalance (ERI) and Intention to Leave (ITL) Siegrist (1996) developed a theoretical model that displays the imbalance experienced when an individual displays high levels of effort and experiences inadequate feeling of gain or reward. He labels this high-cost low-gain condition, EffortReward Imbalance (ERI) (Bakker et al, 2000). Effort at work is expended by employees in the form of motivators. Extrinsic motivators are specific to the job, intrinsic motivators are specific to the person. Extrinsic motivators may include the workplace environment, social climate, flexibility, leadership styles, workplace stress and

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Itention to Leave (ITL)

Figure 2. Siegrist’s Theoretical Model

location, role requirements, safety, communication efforts and, of course, pay (Manion, 2009; Currie and Carr Hill, 2012). Intrinsic motivators may include personal reasons, such as home and family, work/life balance, interpersonal relationships, age/generation, values and ethics, meaningful work, needs and attitudes, autonomy and personal education and professional goals (Manion, 2009; Currie and Carr Hill, 2012). A significant finding was that ‘intrinsic motivation has been found to positively affect behaviour, performance, and well-being’, especially in the workplace (Cogin, 2012). This finding shows the importance to nursing professionals of addressing staffs wants and needs that fuel the identified warning signs. To clarify, when individuals make such efforts, the employer traditionally rewards the employee with money, esteem and status (Bakker et al, 2000). An imbalance arises when the employee feels inequity between their efforts and their rewards—i.e. an ERI, such as ‘achieving at a high level without being offered any promotional prospects’ (Bakker et al, 2000). A review of Siegrist’s literature concludes that experiencing ERI, or ‘reward frustration’, will influence an employee’s desire to quit or Intention to Leave (ITL) (Figure 2). The longitudinal European nurses’ early exit (NEXT) study (n=6469) used the ERI model and confirmed that high effort, low reward and high over-commitment at baseline review predicted newly developed ITL after one year followup (mean age 38 years) (Li et al, 2011). The NEXT authors also did an international analysis of ERI impact and found the results to be the same: ERI leads to ITL. Nurses who were unhappy during the initial review felt more inclined to leave their workplace, even if those feelings at the one year follow-up were not present at the start of questioning. It is important to recognise the ERI-ITL relationship in the nursing profession, so that early signs of ERI can be successfully dealt with, leading to lower staff turnover.

Generation Y characteristics ‘Much of the work on generations has been based on observation rather than large-scale empirical findings, and very little academic research has been done on the characteristics and expectations of generations and their implications for the workplace’ (Cogin, 2012). Examining these characteristics is important for many reasons: ‘Scant evidence [has been produced] regarding the impact of age diversity on human resources management policies and practices; yet, workplaces are becoming increasingly age diverse… Understanding the values that younger generations bring to work will be essential for those who wish to remain competitive in attracting qualified applicants.’ (Cogin, 2012)

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Strengths On first glance at a Generation Y individual, one might notice physical characteristics such as tattoos, piercings and electronic gadgets, such as smart phones (Cogin, 2012). They are noted to be mature, respectful, positive, polite individuals (Cogin, 2012). They tend to exhibit a high degree of altruism—unselfish regard for, or devotion to, the welfare of others. Generation Y enjoys giving back to the community and volunteering. If they believe in the organisation and feel the values of the workplace are in line with their own, they will be dedicated, hard working and full engaged. They truly believe they can and will make a difference (Cogin, 2012; Stanley, 2010). Diversity is a given, as they have grown up believing a mixed society to be the norm and not the exception (Cogin, 2012; Manion, 2009). Generation Y is technologically proficient, or ‘savvy’. Its members are also resilient, fast-learning multitaskers who show practical enterprising and negotiating skills (Jamieson, 2009; Manion, 2009; Stanley, 2010). As a result of witnessing the unstable career paths of their parents, Generation Y members believe job security to be a myth and focus primarily on building and marketing their skills (LavoieTremblay et al, 2010b). Generation Y members have strong feelings about the work environment. They expect it to be safe, flexible, challenging, motivating and empowering. They have high self-esteem and grew up being told by parents and teachers that they ‘can do anything’, and they believe this (Manion, 2009; Cogin 2012). They are confident, vocal about their opinions, believe they can make a difference, and enjoy socialising (Cogin, 2012). This might be why there has been an entrepreneurial business explosion with this emerging generation (Facebook, for instance). Generation Y wants fast-track leadership programmes, and to be recognised and rewarded for their contributions (Lavoie-Tremblay et al, 2010b; Cogin, 2012). Communication is primarily electronic: they prefer texting and emailing to face-to-face conversations. Generation Y nurses are highly educated; they are the first generation instilled with research-based, best-practice methods and outcome data (Chambers, 2010). Generation Y is ‘more numerous, more affluent, better


Effort-Reward Imbalance (ERI)

Finally, Generation Y may have a new idea of career success more concerned with lifestyle than job satisfaction, which could ultimately affect turnover (Cogin, 2012). Examining the strengths and weaknesses of Generation Y helps managers to understand this new generation of staff emerging in practice. Furthermore, the research done on generations in the workplace, however scant, introduces the topic to nursing literature and introduces nurses to the idea of generational differences, alerting them to this new facet of diversity in the workplace. The strengths and limitations of Generation Y were identified from these observations, mainly by Cogin (2012), whose research was done across five countries (USA, Australia, China, Singapore and Germany). The multiple qualitative focus-group analyses done by Lavoie-Tremblay et al (2010a; 2010b) (Canada) and Brunetto et al (2012b) and Brunetto and Shacklock (2012) (Australia) also made a contribution.



nursing development educated and more ethnically diverse than any previous generation’ (Stanley, 2010). These skills and attributes put Generation Y nurses in a position to become the very face of a contemporary 21st-century professional (Jamieson, 2009).

Limitations Generation Y members may be labelled ‘high-maintenance’ (or ‘demanding’), impatient, needing of constant ‘handholding’ and wanting immediate feedback (Chambers, 2010). This cohort demands flexibility—if the workplace is not providing them with the work/life balance they are seeking, they look to move on. Current trends show shorter employment tenures and frequent job hopping among Generation Y (Wieck et al, 2010). They distrust institutions, dislike traditional hierarchy and want minimal rules and bureaucracy. For this generation,‘work is just one priority in life, not the priority’ (Cogin, 2012). Technology does not always have a positive impact. Lacking the social skills for dealing with difficult situations or people, Generation Y members prefer texting, email or social networking online to picking up the phone or having face-to-face conversations (Manion, 2009; Cogin, 2012). Consequently, Generation Y requires constant stimuli and can easily become bored with menial tasks (Table 1).

Turnover An international review of the literature reveals that the turnover rate is 30% the first year of practice and 57% by the second year (Chambers, 2010). The estimated direct cost of replacing a full-time equivalent registered nurse in 2007 in the USA averaged about $36 567 (£24 619) (Robert Wood Johnson (RWJ) Foundation, 2009). Within this cohort, ‘job hopping’ is frequent and thought to be a means of accomplishing career goals. It has been suggested that Generation Y will have up to 15 different roles in their lifetime, three of which have yet to be invented (Jamieson, 2009).

What does Generation Y want in the workplace? Generation Y members assess the work environment as either enriching or a hindrance to their professional development. For this cohort, the social climate of an institution determines frustration versus excitement (Chambers, 2010). Through numerous qualitative studies, Lavoie-Tremblay et al (2010) have found that Generation Y yearns for work environments that enable them to become experts in their field, continue their education, work for an institution that is reputable, and achieve a sense of camaraderie with their peers. A standardised approach to work environments is not successful in addressing the priorities and motivators of each generation. One suggested solution is to create an atmosphere where all feel welcomed and valued, with recognition of values specific to each generational cohort (Wieck et al, 2010).


Impact of the extrinsic motivators and the work environment Physical workplace environment: New nurses are entering a tumultuous practice environment. Institutions are recovering from a nursing shortage, which has lead to short staffing, heavy patient loads, medically complex assignments and daunting shift work (Lavoie-Tremblay et al, 2010). Failure to change


this atmosphere may lead to dissatisfaction and the creation of psychological stress and anxiety about coming to work. Safety:With constant attention on patient acuity, medication errors, staffing ratios and workplace injuries, the workplace must be a safe practice environment. Generation Y members are aware of these ‘hot topics’ on entering the profession and will shy away from institutions where they believe the environment may pose a risk to safe practice. Workplace stress/role requirements: The transition from student nurse to a practising nurse can prove difficult. Unstable practice environments that use floating staff as a means of filling the schedule can lead to anxiety and uncertainty of the new nurse. Lavoie-Tremblay et al (2011) also state that new nurses need psychosocial support in their environment. The following factors encourage staff retention: positive experiences, social support, longer mentorship programmes, recognition and reward, empowerment and addressing the work environment as a whole (for instance, collegiality, safety, appropriate staff/patient ratios). A new nurse might succumb to the common new-nurse stressors, such as insecurity, making mistakes related to workload and acuity, anxiety over new and unforeseen situations and inconsistent expectations from others, and job strain (Lavoie-Tremblay et al, 2008). Murrells et al (2008) write: ‘In the UK preceptorship is not mandatory, however a formal one year preceptorship or probationary year should be considered best practice. Generally supporting nurses during the transition from student to nurse will reap longer-term benefits of reduced turnover, better patient care and reduction in costs, which in the UK can run as high as £10 000 and result in lost productivity’ Leadership: Management faces a large task because Generation Y has high expectations from their management team, such as attending to personal needs, nurturing and support, motivation towards personal accomplishment, professionalism, availability and good people skills (Wieck et al, 2010). Generation Y members respect visionary leaders who communicate, motivate, encourage staff participation, listen to needs, express respect for individual effort and achievement, and praise relentlessly (Wieck et al, 2010; Brunetto et al, 2012a, Brunetto and Shacklock, 2012). Table 1. Generation Y characteristics Strengths

Limitations

■■ High

■■ Want

degree of altruism ■■ Enjoy volunteering ■■ Diverse ■■ Technologically ‘savvy’ ■■ Resilient, fast-learning, multitaskers ■■ High self-esteem ■■ Vocal about their opinions ■■ Believe they can make a difference ■■ Want fast-track leadership programmes

recognition and reward for achievements ■■ Impatient ■■ Demand flexibility ■■ Want work/life balance ■■ Lack communication/social skills ■■ Distrust institutions ■■ Dislike traditional hierarchy ■■ Want minimal rules and bureaucracy

Source: Jamieson, 2009; Manion, 2009; Lavoie-Tremblay et al, 2010a; Cogin 2012

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actions that added value to the institution, such as perfect attendance or staying committed to that institution. Making these rewards transparent so as to not foster resentment from other staff is recommended (Wieck et al, 2010).

Leadership

Communication efforts

Safety

Healthy work environment

Extrinsic motivators

Monetary

Figure 3. Extrinsic motivators

Communication efforts: Since Generation Y dislikes traditional hierarchal management, creative bi-directional communication strategies between supervisors and subordinates are helpful in cultivating positive relationships that might help retention (Brunetto et al, 2012). (‘Creative bi-directional communication’ could be defined as a less formal meeting between nurses and supervisors in which exchange is encouraged and professional rank put to one side.) Monetary: For members of Generation Y, because they value work/life balance, monetary compensation is not a significant motivator. However, it was mentioned throughout the literature that monetary motivators could be used to reward

Impact of the intrinsic motivators and the work environment Healthy interpersonal relationships: Generation Y recognises their entrance into the profession at a novice level and craves frequent positive responses about how they are doing (Cogin, 2012; Manion, 2009). Meaningful work: Generation Yers have an innate desire to do good as they want to play a meaningful role by doing meaningful work that helps others (Wieck et al, 2010). They possess a strong sense of altruism, they would rather trade pay for work that is more meaningful at an agency where they are better appreciated and are clearly heard (Cogin, 2012). Competence and self-efficacy: Members of Generation Y seek constant responses and communication from leadership, they expect their value to the institution to be praised and recognised. While this praise and recognition may seem unrealistic in a fast-paced healthcare environment, it is important to reflect upon the general characteristics of this generation. They are constantly being told they can do anything, change anything or be anything. Generation Y nurses value an institution that allows them to be contributing members of the team, they are confident about voicing their opinions, expect to be listened to and treated with respect and professionalism (Lavoie-Tremblay et al, 2010; Cogin, 2012). Progress: This generation embraces skill-set and career development, and new challenges. Its members thrive on the rush of a new opportunities (Cogin, 2012), seeking a workplace that provides them with opportunities for professional growth and development (Lavoie-Tremblay et al, 2010).They recognise that life-long learning is necessary for personal growth and expect ‘to be placed in challenging situations where they can further their education and skills’ (Lavoie-Tremblay et al, 2010). ‘A sense of progress builds momentum and enthusiasm, resulting in the energy of commitment’ (Manion, 2009). The RCN has also recommended protecting funding for nurse training and development. Autonomy: ‘New nurses have described work environments as authoritarian, intellectually-oppressive and cognitively restrictive’ (Lavoie-Tremblay et al, 2008). This generation craves flexibility and work/life balance. Given the choice, they would telecommute, work part-time and leave the workforce to raise a family and pursue further education (Lavoie-Tremblay et al, 2008). This generation would give up monetary compensation in exchange for becoming an engaged parent, a loyal friend, socially active and live a full and balanced life (Cogin, 2012). This reality poses a paradox for hospital systems needing a stable and experienced workforce.

Skills for Health

Figure 4. Generation Y nurses crave an environment that allows flexibility and gives them the work/life balance they value

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Many of these motivators are addressed by the Code of Conduct and National Minimum Training Standards for healthcare support workers set forth by Skills for Care (2011) in the UK (‘Skills for Health acts as the voice of


Workplace stress/role requirements



nursing development healthcare employers in the skills system’). The intrinsic and extrinsic motivators identified can be found throughout their ten focus areas: The new minimum training standards focus on 10 areas that are designed to cover the key knowledge for health and care workers and set out what should be covered during a period of induction in the first weeks of employment: The roles of the Healthcare Support Worker and Adult Social Care Worker, Your personal development, Effective communication, Equality, diversity and inclusion, Duty of care, Safeguarding, Person-centred care and support, Health and safety, Handling information, Infection prevention and control. The standards make a conscious effort to address and acknowledge the needs of healthcare personnel in all generations. By recognising the ten focus areas, a movement towards the four international priorities put forth by The International Centre for Human Resources in Nursing is integrated.

Recommendations Suggestions for change include: ■■ Openly acknowledge the differences between generations of nurses ■■ Communicate clearly the value of management parameters for an efficiently run hospital, while using leadership strategies to develop human-resource potential ■■ Evolve the culture of the environment to acknowledge the needs of Generation Y nurses ■■ Provide support that reinforces skills sets and competencies ■■ Support controlled seminal research rather than sole focusgroup perspectives ■■ Form nurse-specific focus groups according to generation BJN (Baby Boomer, X, Y).


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Competence and selfefficacy Meaningful work

Healthy interpersonal relationships

Progress/ career development

Intrinsic motivators

Autonomy

Figure 5. Intrinsic motivators

26(1):2–8 (quiz 9-10). doi: 10.1097/NND.0b013e3181a68951 Lavoie-Tremblay M, O’Brien-Pallas L, Gelinas C, Desforges N, Marchionni C (2008) Addressing the turnover issue among new nurses from a generational viewpoint. J Nur Manag 16(6): 724–33 doi:10.1111/j.1365-2934.2007.00828.x Lavoie-Tremblay M, Paquet M, Duchesne M, Santo A, Gavrancic A, Courcy F, Gagnon S (2010) Retaining nurses and other hospital workers: an intergenerational perspective of the work climate. J Nurs Scholarsh 42(4): 414–22. doi: 10.1111/j.1547-5069.2010.01370.x. Lavoie-Tremblay M, Paquet M, Marchionni C, Drevniok U (2011) Turnover intention among new nurses: a generational perspective. J Nurses Staff Dev 27(1): 39–45. doi: 10.1097/NND.0b013e31819945c1 Lavoie-Tremblay M, Wright D, Desforges N, Gélinas C, Marchionni C, Drevniok U (2008) Creating a healthy workplace for new-generation nurses. J Nurs Scholarsh 40(3): 290–7. doi: 10.1111/j.1547-5069.2008.00240.x. Li J, Galatsch M, Siegrist J, Müller B, Hasselhorn H (2011) Reward frustration at work and intention to leave the nursing profession—prospective results from the European longitudinal NEXT study. Int J Nurs Stud 48(5): 628–35. doi: 10.1016/j.ijnurstu.2010.09.011 Manion J (2009) Managing the Multigenerational Workforce: Managerial and Policy Implications. International Council of Nurses (ICN), Geneva, Switzerland Murrells T, Robinson S, Griffiths P (2008) Job satisfaction trends during nurses’ early career. BMC Nurs 7(7). doi:10.1186/1472-6955-7-7 Robert Wood Johnson Foundation (RWJ) (2009) Retaining Experienced Nurses Research Initiative—Final Report. Lewis Group, Princeton, NJ, USA Royal College of Nursing (RCN) (2013) Frontline First: Nursing on red alert: April 2013. http://tinyurl.com/oh4cskn(accessed 25 October 2013) Siegrist J (1996) Adverse health effects of high effort-low reward conditions. J Occup Health Psychol 1(1): 27–41 Skills for Care (2011) Code of Conduct Healthcare Support and National Minimum Training Standards. http://tinyurl.com/qbesb64 (accessed 25 October 2013) Stanley D (2010) Multigenerational workforce issues and their implications for leadership in nursing. J Nurs Manag 18(7): 846–52. doi:10.1111/j.13652834.2010.01158.x Wieck K, Dols J, Landrum P (2010) Retention priorities for the intergenerational nurse workforce. Nurs Forum 45(1): 7–17. doi:10.1111/j.17446198.2009.00159.x Wikipedia (2013) Roper-Logan-Tierney model of nursing. http://tinyurl.com/ q468ypu (accessed 24 October 2013)

Key points n A

generation is an aggregate of people who share birth years, a common location in history, a collective persona and may experience greater comfort interacting with one another

n Those

of the same generation often share similar motivations, morals, ethics, values and principles

n ‘Generation

Y’ refers to those people born between 1980 and 2000 and follows the preceding ‘Generation X’

n Effort

at work is expended by employees in the form of motivators. Extrinsic motivators are specific to the job, intrinsic motivators to the person

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