Portal de Periódicos da CAPES

Breaking barriers

2025; Lippincott Williams & Wilkins; Linguagem: Inglês

10.1097/nmg.0000000000000214

1538-8670

Barbara Alba, Gwen Mancuso, Kerry Hensler, David Nicholas,

Psychological and Temporal Perspectives Research

FigureCurrently, five generations occupy the nursing workforce: the Silent Generation, baby boomers, Generation X (Gen X), millennials, and Generation Z (Gen Z). Each one of these groups bring distinct values and characteristics to the workplace with ideas and preferences reflective of their era.1 Such diversity can either enrich a workforce with shared attributes and contributions or cause discord with differences that complicate an already complex healthcare system.2 Nurse leaders play a key role in integrating these groups into harmonious teams while recognizing the impact on nurse engagement and retention.3,4 Understanding the advantages and challenges nurse leaders face in managing a multigenerational workforce is an essential first step in developing focused strategies to promote strong nursing teams. Therefore, the purpose of this study is to provide a firsthand account of understanding nurse leaders' perceptions and experiences managing a multigenerational workforce. LITERATURE REVIEW Findings on nurse engagement and retention have been linked to generational differences. Studies have found the Silent Generation to be the most engaged, followed by baby boomers, Gen X, and finally, millennials.3 Compounding these findings is that millennials, as the nation's largest living adult generation, have higher odds for intention to leave than their Gen X and baby boomer colleagues.4,5 Using generational-specific engagement strategies, nurse leaders have become responsible, more than ever, to create collaborative working environments where respect is central and minimizing intention to leave is prioritized.6,7 With such high stakes, understanding the leader's role in managing a multigenerational workforce becomes pivotal. However, research on this topic is limited, as are the resources to inform nurse leaders. Much of the literature over the last 5 to 6 years provides discussion or advice for leaders but lacks scientific rigor.1,8 One systematic review on multigenerational teams, which spans more than 19 years, identifies leadership as a theme in 13 of 121 articles. Of the 13 articles, 4 were within healthcare.9 These results substantiate the need for more robust research on the topic in healthcare and, more specifically, nursing. Furthermore, other studies on leadership are narrow in scope, focusing only on one group, such as millennials, whereas others address outcomes such as retention and engagement.6,7,10,11 Few studies specifically address nurse leaders' perceptions and experiences in managing a multigenerational workforce. This study begins to fill this gap. Adding some confusion to the topic of multigenerational workforces is a lack of concept clarity. For decades, philosophers have attempted to provide some understanding behind the term "generation," but their theoretical foundations are dense in nature, with limited applicability to nursing practice. The seminal work of Mannheim describes a generation as a lifespan influenced by the historical events of that time.12 Strauss and Howe describe generation as a cohort group whose length approximates the span of a life where boundaries are fixed by peer personality.13 Ortega y Gasset suggests that members of a generation come into the world with certain characteristics distinguishing them from the previous generation.14 For this study, a generation is simply defined as a cohort of people born during a certain period categorized by year and described by generational work values (see Table 1).5,15-17 In the context of this study, the generational time periods are as follows: Silent Generation: 1928 to 1945 Baby boomers: 1946 to 1964 Gen X: 1965 to 1980 Millennials: 1981 to 1996 Gen Z: 1997 to 2012 TABLE 1: - Generational work values16,17 Generation Characteristics Silent Hardworking with a strong work ethic, respect authority, value job security, appreciate teamwork, make decisions based on the common good, prefer face-to-face communication, enjoy mentoring Baby boomers "Workaholics" (live to work), need meaning and challenging work, good at human relationships, team players, prefer personal interaction when communicating Gen X Adaptable to change, risk takers, outcomes-oriented, value autonomy, seek work-life balance, (work to live), desire development opportunities Millennials Tech savvy, multitasking capability, risk takers, embrace change, seek constant feedback and instant gratification, loyal if satisfied at work, seek work-life balance and job flexibility Gen Z Enjoy work that's exciting and interesting, require job security, prioritize job benefits, enjoy establishing friendships at work, seek work-life balance, want opportunities for learning and advancement, altruistic METHODS Design A descriptive qualitative design with focus group methodology frames this multisite study. Three focus groups included leaders at the nurse manager level. Focus groups were conducted by generation as described by Fry.5 Sample Nurse managers were recruited from seven campuses within a large hospital system. The hospitals varied in scope, including acute care, behavioral health, and children's specialty. They also varied in size from large academic medical centers to small community-based hospitals. Inclusion criteria sought manager-level leaders born no later than 1996, excluding any Gen Z leaders. Recruitment was conducted via an emailed letter explaining the study to 131 inpatient and outpatient nurse managers. A total of 16 nurse managers volunteered to participate in the study. Three groups were formed by generation: three baby boomers (18.8%), five Gen Xers (31.2%), and eight millennials (50%). A short demographic survey followed. Of the sample, most were White (60%) females (87.5%). The average number of years worked was 19, with a 9-year average of time worked in nursing leadership. The majority of the participants held a master's degree or higher (93.7%), with a third holding nurse executive board certification (31.2%) (see Table 2). TABLE 2: - Demographic characteristics of respondents (N = 16) Category n % Generation Baby boomers 3 18.8 Gen X 5 31.2 Millennials 8 50 Gender Male 2 12.5 Female 14 87.5 Ethnicity Hispanic 2 13.3 Non-Hispanic 13 87 Race White 9 60 Black/African American 4 26.7 Native Hawaiian/Hawaiian/Pacific Islander 1 6.7 Other 1 6.7 Education Bachelor's 1 6.3 Master's 13 81.2 Doctorate 2 12.5 Board certification Yes 5 31.2 No 11 68.8 Data collection Institutional review board exempt status was attained. Informed consents were collected from each participant prior to each focus group session. All participants were informed about the purpose and voluntary nature of their participation along with their right to withdraw. Anonymity was supported through numerical coding of each participant. Three face-to-face, semistructured, 90-minute interviews were conducted and recorded via a secured virtual platform. To maintain interview reliability, the coinvestigator facilitated all interviews using seven open-ended questions centered on the participants' experiences, behaviors, feelings, and opinions regarding their management of a multigenerational nursing workforce. The workforce was defined as all employees who report directly to the nurse manager. This definition, as well as the purpose of the study, was explained to the participants at the beginning of each focus group session. Data analysis The recorded interviews were transcribed verbatim using a transcription service. Transcripts were then cross-checked with the recordings to ensure their accuracy and returned to the participants for member checking, resulting in some minor edits. Coding followed using the six-phase approach to thematic analysis as described by Braun and Clarke.18 Rigor The researchers used Lincoln and Guba's criteria of credibility, transferability, dependability, and confirmability to ensure the trustworthiness of the study.19 Using method triangulation, credibility was established with data collected from three distinct respondent groups. Member checking of the transcripts further supported credibility by ensuring the accuracy of participants' responses. Transferability was achieved using thematic analysis capturing rich descriptions of participants' experiences. For dependability, an external auditor reviewed the data and results for accuracy. Confirmability was established using an audit trail consisting of records and results of the inquiry, which the auditor followed. RESULTS Three themes and six subthemes emerged from the data (see Figure 1). Theme 1: Generation gap Interviews confirmed that a generation gap does exist among the four generations: baby boomers, Gen X, millennials, and Gen Z. The gap revealed itself through different generational behaviors captured through two subthemes: commitment and responsibility.FIGURE 1:: Themes and subthemes1.1 Commitment. Generational differences were illuminated through varying degrees of commitment to the bedside. Distinction was drawn between "40- and 50-year-olds and those just entering the profession." Gen Xers were described as "passionate about their work," and, despite having advanced practice degrees, their commitment to the bedside was seen as steady. Conversely, Gen Zs were described as "always looking for the next thing," prioritizing their advanced degrees while thinking about or acting on their next job opportunity as "they all want to be nurse practitioners." Bedside nursing was defined as a "stepping stone" for the Gen Zs entering the profession. One millennial manager stated: "The Gen Z folks tend to have specific plans for their next step after being at the bedside. I interviewed two new grads, one is in an NP program, and one is in a DNP program. Their goals are not to stay at the bedside. It's just interesting to me that they almost view bedside nursing as a stepping stone, a very brief stepping stone." With the younger generations pursuing advanced degrees, participants also expressed struggling with a rise in requests for part-time status as Gen Zs claim exhaustion from juggling full-time work and school. One baby boomer expressed, "I have to take a deep breath every time these requests come." She remembered a time when she managed work, school, and a family. However, she reminded herself that changing times require a shift in thought: "I must meet them where they're at rather than them meeting me where I'm at." With shifts in commitment, the participants aired strong emotions regarding the future of nursing and the quality of care as boomers retire. Experience becomes "diluted" when nurses leave the bedside after only 1 to 2 years in practice. Further commitment differences were highlighted as participants described Gen Zs as "individualistic," prioritizing their personal needs over professional needs. The opposite held true for the older generations. Examples of these differences were demonstrated using sick and benefit time. One participant described a sense of entitlement from Gen Zs, who claim, "I get one sick day a month. I can't take it with me, so I'm going to use [it]." The opposite held true for the older generations. These differing attitudes were summed up by one Gen X manager: "They never see the department. I can't give every single person off every Friday, or else how will I run this unit? They don't care about [that]. I've also noticed a difference in the behavior around benefit time and sick time. For instance, I have a nurse who's on probation and has no issue calling out. Whereas I have some of my older nurses who will try everything in their power to get a switch. They recognize that, if they call out, the team is going to be short, and they don't want to do that to their coworkers. The younger nurses don't really care about impact. I had one ask for a holiday and, when she was denied, she called out sick." Commitment for the younger nurses revealed itself in their involvement with unit-based activities, in which they were found to be more engaged than their senior counterparts, who "need a little push." One Gen Xer described her Unit Practice Council chairpersons as Gen Zs, out of school a year, and doing a great job under the guidance of their millennial colleagues. Overall, Gen Zs were described as very creative. As one Gen Xer explained: "I think the seniors' weakness would be in engagement. They're like, 'I'll join the huddles, I'll join meetings,' but not much of 'I'll lead the project.' For our youngest generation, they're very engaged and energetic. They want to lead, they want to start a project, they want to start research, they want to be part of something." 1.2 Responsibility. Responsibility explains participants' experience in managing the generationally different behaviors related to nursing practice. Participants depicted the "task-driven" nature of the younger nurses, portrayed as keeping their eyes directly on the patient's wristband, scanning, doing their med pass, and leaving before asking the patient if they need anything else. One millennial manager stated, "I feel like the older generations take responsibility for all levels of care versus the newer generation, who are just in and out." A Gen X manager shared a similar experience by describing the attention to detail owed to his own generation. He explains being challenged by millennials and Gen Zs, who are "more lax" about things such as bedside handoffs, baths, and documentation, causing him to follow up to ensure care is completed. Another aspect of responsibility had some participants describing "pushback" from the younger generations. Statements such as, "That's not my patient," or "It's the nurses aide's job to do vitals, not mine," concerned nurse managers regarding how these attitudes impact nursing care. Additionally, one boomer explained the need to redirect younger nurses who decline care for a patient 2 days in a row claiming "burnout" from a difficult patient, something not witnessed among the older generations. Theme 2: Let's strategize Let's strategize discusses the multiple strategies participants use to improve communication with their multigenerational workforce. The subtheme seven times, seven ways explains these strategies. Additionally, because words matter, nurse managers modify their communication styles to meet the needs of each generation. 2.1 Words matter. Leaders who use a "words matter" approach described their tailored approaches for delivering feedback to each generation as requiring a bit more tiptoeing around discussions with the younger nurses, whereas the older groups prefer "straight talk." A Gen Xer described using the "sandwich" approach to convey feedback to the younger generations. This approach was explained as "positive, negative, positive" conversations that usually follow: you're doing a great job, here are the opportunities, and keep up the good work. These tactics were said to be viewed by the older generations as excessive and unnecessary. One participant also explained the need to soften her words to avoid "hurt feelings" when delivering feedback to the younger nurses, whereas another participant described preparing by having tissues available, recalling a conversation with a young nurse who warned, "I'm going to cry no matter what." "I feel like I can be a little bit more straightforward with my older generation, whereas [with] my younger generations, I feel like I have to be very careful with my words, kind of, say a few good things that we've been doing to kind of pad any of the negative things that I may have to say." 2.2 Seven times, seven ways. With so much information being disseminated daily, nurse managers explain their challenges in making sure all employees receive it. They express being further challenged in knowing that each generation has a preference for how they like to receive information. For example, Gen Xers and baby boomers like face-to-face conversations, whereas the younger generation prefers more technologic methods. "Seven times, seven ways" was discussed as a strategy used to satisfy these individualized preferences. It was explained as delivering a message through seven different modes of communication, enabling everyone to receive the message seven times. One nurse manager conveyed, "There was a time when maybe two or three ways would do, but this has changed over the years requiring something for everyone." Different methods include everything from information posting and emails for the older generations and WhatsApp for the younger generation. "I use different kinds of communications platforms. You have phones, email, visibility board. I even include text message. I also asked the group how they want to receive updates." Theme 3: Mutuality As the final theme, mutuality finds understanding and support among all generations. Here, leaders speak of the ways their multigenerational workforces join, despite the differences, with a respect for each other. This mutuality was highlighted through the subthemes mentorship and beyond mentorship. 3.1 Mentorship. Focus groups all supported having formal mentorship programs, where a mentor is assigned to each new nurse. The participants highlighted the success of these programs, with nurses working together on projects that led some to national conferences. However, more than formal mentorship, participants mentioned an informal or "natural" mentorship that occurs as the older generations take the younger ones under their wing. While the younger generations reap the wisdom of their senior colleagues, the latter were said to realize that mentoring is an investment in the future. "I see sort of a natural mentorship happening with some of our older nurses to the younger, newer nurses. I think that some of our older nurses realize that a lot of these nurses come through, they spend maybe a year, maybe two with us and then they move on. So, because of that, they really want to invest in them to get them to stay." In addition to learning the clinical aspects of the job, participants addressed some of the softer skills that natural mentorship had to offer. "I feel like they're learning a lot from the older generation about strength and calmness at the bedside. Whatever comes through that door, the older are like, we're all here together." 3.2 Beyond mentorship. Beyond mentorship conveys participants' pride in their multigenerational workforce, with one explaining how fortunate she was to have a team that "jives and works" so well together. Leaders listed strategies they use to encourage this camaraderie. One strategy uses a primary preceptor and a secondary preceptor from different generations, giving new nurses perspectives through both lenses. Another is mindful to have all generations represented when establishing a new unit initiative. Nurse leaders highlighted the reciprocity between the age groups as nurses tap into each other's strengths. "I do think that they're able to recognize their differences as well as tap into each other's strengths. I see a lot of my older nurses tapping into my younger crowd asking for help to fix a phone or print a label from a new system. Also very naturally, when we have an emergency on the unit or a difficult situation going on, I see my younger nurses just clinging to my older nurses for protection and guidance." The younger generations were also described as bringing a sense of humor and lightheartedness to the job. As one baby boomer explained: "I do feel like the younger nurses add a level of levity to the unit with laughter and joking around with each other. The older nurses do enjoy that, especially when the younger ones show them a funny TikTok or something like that." DISCUSSION The literature on generational job commitment is limited and mixed. Some early studies suggest Gen Y to be the most committed, whereas other more recent studies claim Gen X to be most committed.20,21 Adding to the confusion, terms like affective, professional, and organizational commitment are used to describe the diverse types of commitment measured.22,23 However, in the present study, commitment isn't measured, but perceived as virtue-based. It's grounded in professional integrity and quality of care, which speaks not only to commitment, but also to responsibility, which go hand in hand. Overall, the younger generations were perceived as less virtue- and more value-based than their older colleagues. Younger nurses were described as individualistic, prioritizing personal life over work life. This mentality was witnessed in behaviors surrounding their use of sick and benefit time, which isn't surprising given that Gen Zs rate their personal needs or benefits high on the list of work-related values.16 Further, other evidence shows that there's a greater emphasis on work-life balance as generational cohorts get younger. Here, it's concluded that younger generations value flexibility and freedom in their workplaces, whereas the older generations place greater emphasis on discipline and hard work.24 Similarly felt was a reduced sense of job responsibility from younger nurses, who were perceived as dismissive when asked to complete routine nursing tasks. This "noncompliance" translates into behaviors that challenge workplace rules and norms, with findings that support younger groups to be less compliant when compared with their seniors.24 At the bedside, younger nurses were viewed to be task-oriented when compared with their older colleagues. This, however, isn't unusual behavior for these young novice and advanced beginner nurses who are task-oriented, with an inability to prioritize care.25 Furthermore, let's not forget that, due to a pandemic, many Gen Zs entering the workforce during the last year or so have had limited practical experience, affecting their clinical skills.26,27 With time, experience, and guidance, younger nurses can overcome these limitations and become more virtue-based. However, this may be a lofty goal given the short tenure of the Gen Zs who are described as using the bedside as a stepping stone to the next career goal. Here, findings support career advancement and professional development as priorities for Gen Zs, who were perceived as less committed to their present than their future.28 With these shifts in commitment, there's deep concern regarding the future of nursing and the quality of care, as experience becomes diluted with nurses who leave the bedside after only 1 to 2 years in practice. A notable finding in this study is that participants described the younger nurses as more committed in unit activities compared with their older counterparts, who were described as needing a "little push" to become more involved. This finding contradicts some of the literature that supports nurses from the Silent Generation to be the most engaged, followed by baby boomers, Gen X, and millennials.3 However, for this study, engagement may be a byproduct of the younger generation's commitment toward their future goals, which is sparked by the organization's commitment to excellence. Affording them numerous professional growth opportunities, nurses engage in performance improvement initiatives and evidence-based practice projects as they lead from the bedside. Furthermore, nurses are encouraged to pursue certifications, hold leadership positions on unit councils, and return to school for advanced degrees that are supported through tuition reimbursement programs. Young nurses begin to build their portfolios as they prepare for the next step in their careers. Although managers in this study expressed concern about the possibility of higher turnover rates, it becomes the leader's responsibility to promote this career growth, despite its consequences. These investments develop the front line while increasing the chances of retaining strong internal talent.8 While helping to keep their teams informed and engaged, participants in this study had an astute awareness of the importance of communication when interacting with their teams. As "words matter," their sophisticated approaches to delivering feedback are tailored to the needs of each generation. Younger nurses often respond better to more subtle and nuanced approaches, whereas older nurses generally prefer direct and straightforward communication. Managers also relied on different strategies to meet communication preferences. Here, managers combine a "basket of skills" with an intergenerational intelligence to meet employees' individual needs. Improving managers' awareness and strengthening these skills enable a better connection with younger employees, while also improving labor turnover and organizational commitment.29 The final theme of this study focuses on mutuality. Leaders agreed that, despite the differences, there exists a camaraderie among the generations, which is facilitated through mentorship. Nurse leaders spoke of both formal and informal or "natural" mentorship with particular emphasis on the latter. Here, they witnessed senior nurses guiding younger nurses with a mindfulness toward retaining them while also understanding that mentorship is an investment in the future.30 These behaviors dispel claims for what has been known for years as "nurses eating their young," a phase used to illustrate intergenerational incivility and bullying.31 Beyond mentorship, nurse leaders highlight the reciprocity among the age groups as nurses tap into each other's strengths, some of which are familiarity with technology for the younger generations and clinical expertise for the older generations. This reverse or bidirectional mentoring fosters mutuality while sharing a generational middle ground.30,32 LIMITATIONS This study had several limitations. First, underrepresentation of the boomer group and no representation of the Silent Generation group present bias, which gave millennials and Gen X the most voice. Additionally, by nature of focus groups, some participants dominated responses. Also, the sample represented nurse managers from the same hospital system, where organizational standards, values, and goals are standardized, which may limit the transferability of this study. Participants often referred to generations in terms of "younger" or "older," which sometimes challenged the ability to fully capture the behaviors of a specific generational group. NURSING IMPLICATIONS This study provides an understanding of nurse leaders' experiences managing a multigenerational workforce. Research on this topic is limited, as are the resources to inform nurse managers, presenting many research opportunities. Additionally, implications for nursing practice reflect focused strategies in which nurse managers consider all generations. Recruitment for nursing councils and committees requires the experience of older nurses and the innovation of the younger nurses. Leaders need to embrace and encourage intergenerational mentorship as a "best practice." Other implications for practice include supporting succession planning with the intention of retaining younger nurses for next-level unit leadership opportunities. Finally, because it's known that millennials and Gen Xers value flexibility and freedom in their workplaces, all generations could benefit from flexible scheduling practices, giving nurses the autonomy to manage their own schedules. THE LEADERSHIP VOICE The literature on generational characteristics spans generations. However, few studies have granted a voice to the nurse leader. In pursuit of understanding their perceptions and experiences while managing a multigenerational workforce, this study draws on firsthand accounts of these experiences. Through focus group interviews, nurse managers discussed their challenges and ways to overcome them. Participants' creative strategies will inform other nurse managers while helping them to meet the needs of their diverse workforces. This study shows that generational differences can be harnessed in a positive way, using strategies to build cohesive and productive teams. Breaking barriers: A qualitative study on nurse managers' perceptions and experiences in managing a multigenerational nursing workforce TEST INSTRUCTIONS Read the article. The test for this nursing continuing professional development (NCPD) activity is to be taken online at www.NursingCenter.com/CE You'll need to create an account (it's free!) and log in to access My Planner before taking online tests. Your planner will keep track of all your Lippincott Professional Development online NCPD activities for you. There's only one correct answer for each question. A passing score for this test is 8 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost. 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