On one hand, we have a new graduate nurse. She grew up in the 1990s, had many material and educational advantages thanks to her affluent parents, and sends about 500 text messages to her friends each month. On the other hand, we have a seasoned nurse manager. She grew up in the 1960s, worked her way through nursing school, and still thinks the best way to reach someone is the telephone. And so the stage is set for a collision.
"There's puzzlement on both sides," says Sean Clarke, RN, PhD, CRNP, FAAN, an associate professor of nursing at the University of Pennsylvania and Associate Director of the Center for Health Outcomes and Policy Research there. "It's 'Why are new grads like this?' and the reverse side, 'Why are these people so uptight?'" Clarke spoke about the generational differences and the need for some changes in thinking in nursing to a packed ballroom at the Nursing Management Congress in Chicago last week.
"We are seeing quite a difference in culture and style between current managers and new folks coming out of school," says Clarke, who has been studying the trends for a decade. "It's kind of difficult to talk about it scientifically, but anecdotally, they are not speaking the same language."
Instead of focusing on the gap, however, Clarke says that the two groups need to find some common ground. First, to lay a foundation, he pointed to the major areas of difference:
- Attitudes toward work and the work of nursing
- Attitudes/expectations about responsibility
- Attitudes/expectations about participation on teams
- Communication style and communication channels
- Experiences within the profession depending on entry point (salaries, working conditions, prospects)
"Nurses, teachers, doctors, when they look at a new crop of people, they say, 'In my day . . . ' or 'When I was training . . .' People are expected to do their time," Clarke says. "Now, new graduates keep hearing shortage, shortage, shortage, so they are bewildered when they hear they will be stuck on a unit that's their second or third choice, stuck working nights, or stuck working holidays for any amount of time."
The commitment to standards in nursing is still essential, Clarke says, but some evolution may be necessary.
"We're very tradition-bound in nursing," he says. "Attitudes and approaches need to be updated in some way."
And if they aren't? "[Organizations] are going to have major recruiting and retention problems," Clarke says. "Facilities and units that don't adapt will have staffing shortages that have serious effects on quality of care."
So, how can we cross the bridge? How can the two generations start working on the same page in order to curb the nursing shortage and improve care at the same time? Clarke laid out some new ideas for nurse managers:
- Consistent, honest feedback on performance in terms of technical proficiency, contributions to the team, and leadership and communication
- Learner-centered, practical, and technology-based orientation, and continuing competency approaches wherever possible
- Recognize that universal needs for variety, challenge, recognition, and ownership may be more acute in a generation of multi-taskers driven to succeed
- Clear expectations, as new graduates likely went through education where instructions and criteria were very clearly laid out
"[New graduates] are intolerant of 'You did a good job' in general," Clarke says. "The new generation wants to know absolute specifics."
Clarke concludes that there is a lot to gain from adapting and evolving with the new graduates. Among several potential improvements, he included:
- An insistence on better use of information technology
- Clearer guidelines for performance, more consistent and reliable feedback
- A healthier approach to difference and diversity in the healthcare workplace
- Increased attractiveness of work and workplaces for all generations and better patient and facility outcomes in the long run
Of course, Clarke realizes the changes are part of a process. Nursing is in a state of transition, and a manager's job is far from easy.
"This is one of many different plates a nurse manager may be spinning," he says. "They are dealing with budgets, increasingly sick patient populations . . . We do need to evolve, but there is a lot of other turbulence going on."