By Jennifer Thew, RN
Think back on your nursing career and try to pinpoint the moment you felt like a "real nurse." Did you start an IV that seemed impossible? Did you notice a patient was declining before anyone else did and take action? Did you receive a heartfelt thank-you note from someone you cared for?
You probably remember the specifics of that moment like it just happened.
However, Heather Caramanzana, PhD, RN-BC, CRRN, nurse manager, brain injury unit and rehab at Northwell Health's Glen Cove Hospital in New York, noticed many millennial nurses couldn't identify that touchstone moment.
"I was in professional staff development as a nurse educator, and I noticed nurses who had successfully completed orientation were coming to me saying they didn't feel like a nurse. They were inquiring about different positions in nursing and some said that nursing might not be the right fit for them," she recalls.
Caramanzana wondered why this was happening, so she shadowed the nurses to shed light on the issue.
"I observed the way they spoke with patients," she says. "[Their conversations were] very brief. I didn't really feel like they connected with patients, and I even got some feedback from the patients that they felt like the nurses were just doing their job [rotely; like the nurses] weren't really connecting with them and didn't have compassion for them."
As one study finds, the quality of nurse and patient communication can affect HCAHPS scores. After implementing a customized nurse training program known as PatientSET, one hospital found that after the training, patients were 15% more likely to be "most satisfied" with communication with nurses, and patients were 33% more likely to be "satisfied" with their discharge information.
Caramanzana gave the nurses feedback about her observations and coached them on how to make connections in the short moments they had with patients. For example, she advised they look around the room and ask about patients' family pictures or come out from behind the computer screen to make eye contact with the patients.
"It was just little things like that. I worked with [the nurses] and then, all of a sudden, they felt much more fulfilled in their jobs," she says.
Caramanzana began to wonder if feeling disconnected to patients was influencing how these nurses felt about their nursing careers.
At the time, Caramanzana was enrolled in a PhD program and decided to study what connecting with patients means to millennial nurses. As a result, she was able to get their perspectives and uncover themes regarding their experiences. She also identified the needs of millennial nurses in communicating empathy and compassion with patients.
By understanding millennial nurses' experiences connecting with patients, nurse leaders can help this new generation of nurses develop skills for transpersonal, caring relationships that benefit the nurse, the patient, and the organization.
About the study
For her research, Caramanzana posed the question, "What is the experience of the millennial nurse connecting with patients in the 21st century?"
Through face-to-face interviews and field notes, she collected data from 12 millennial nurses with at least two years' hospital work experience in New York City and Long Island, New York. The nurses had to have been born between 1982 to 2000 and self-identify as a millennial.
The 8 Themes of Connection
Out of Caramanzana's data, eight themes about millennial nurses' experiences connecting with patients arose.
1: The Void: Into the Darkness
The study participants voiced an awareness of the importance of forming connections with patients, Caramanzana found.
"They described the empty experience of just completing the technical tasks of nursing," she says. And they voiced that this experience left them feeling unfulfilled.
In one anecdote relayed to Caramanzana, an orientee told her preceptor she didn't feel like she was "enough" and that nursing wasn't for her.
"The orientee said, 'I really don't feel like I am doing nursing,' " Caramanzana says. "Even though she was doing all the technical skills. She just felt an emptiness."
2. Unconnected: Unable to Find the Light
During Caramanzana's interviews, the study participants expressed feelings of failure or guilt when they failed to connect with patients.
"It weighed heavily on them. I know that's when they felt really overwhelmed in their assignments because, for them, it's like caring is a separate thing. They don't realize they can incorporate it when they are doing all their technical tasks," she says.
3. Uncomfortable: Patients as Strangers
Millennial nurses told Caramanzana they often felt uncomfortable initiating conversations with patients.
"It was a real stretch for the [nurses] to just strike up a conversation if it was something that [did not] pertain to an assessment," Caramanzana says.
"I heard that a lot [from the millennial nurses]," she says. [They would say], 'I'm just uncomfortable engaging in conversation with people I really don't know. I feel, perhaps, I'm not being professional.' "
4. Art of Caring: Not a Priority
Time was identified as a barrier to forming connections with patients, according to the study participants.
The nurses said that technical skills and procedures took precedence over establishing connections with patients, and when the nurses were busy, the technical tasks needed to come first.
As Caramanzana points out, the two things don't have to be separated.
"Caring is just as important as the technical skills and that is not something that, if they're feeling overwhelmed, they can just leave to the side," she says.
5. Becoming: Real RN
"In this theme, participants described experiences of what it felt like when they made their first connection with a patient and how it impacted their perception of nursing in a very positive way—how it really changed them [at their] core," Caramanzana says.
6. Fulfillment: Giving Through Receiving
In this theme, survey participants described a passionate association between communication, compassion, and their own well-being, Caramanzana says.
"They said when they do connect with patients, not only did the patients benefit but they benefited. [also]. They felt much better about themselves. They felt fulfilled as a person and as a nurse," she says.
7. Enlightenment: Turning on the Light
All 12 study participants identified a need for more knowledge about the concept of transpersonal caring relationships and how to form them.
One participant remarked that while she had heard about the idea of transpersonal relationships in nursing school, some of her friends who had gone through other nursing programs had not.
"In general, it should always be something that they're educated on," Caramanzana says.
8. Guidance: Educational Needs
"Every single one of them wanted more simulation with [communication and connection skills]," Caramanzana says. "They wanted more immediate feedback on how they can improve."
What nurse leaders can do
As Caramanzana uncovered, when nurses don't make a connection with patients it can also affect nurse retention.
For example, dissatisfied nurses are more likely to leave their jobs. The 10-year RN Work Project study found 17% of newly licensed RNs leave their first nursing job within the first year and 33% leave within two years.
According to the 2019 National HealthCare Retention & RN Staffing Report by NSI Nursing Solutions, Inc., the average cost of turnover for a bedside RN is $52,100 and ranges from $40,300 to $64,000 resulting in the average hospital losing $4.4 million to $6.9 million. Caramanzana advocates for increased education for nurses around communication and connection with patients.
"I think in both academia and [in] the profession, we need to evolve and change how we educate nurses. As nurse educators, [especially with] with new orientees, we need to be focused on teaching and assessing how they form connections with patients," she says.
For example, she encourages preceptors to observe orientees' interactions with patients and give them feedback on their interpersonal skills.
"Plus, with all the annual skills [reviews] we do in a hospital—like how to change a central line dressing—we should also educate on caring skills and how people can improve those because everybody can benefit," she says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.