Arkansas Times
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My Generation

Walk around any hospital or nursing home or visit virtually any clinic and you will immediately notice the incredible diversity of the nursing workforce. From “old school” nurses to the millennial generation, from the influx of men in the field to people of various ethnic backgrounds, today’s marketplace demonstrates room for a little bit of everything.

“The nursing workplace today is multi-generational,” said Shelley Austin, DNP, RN of Henderson State University. “There are new graduate nurses of all ages joining the workforce, as Baby Boomers put off retirement. Generations XYZ and Millennials are the best at technology, while the Baby Boomers are more thorough. Allowing all age groups to offer their expertise is pertinent to the benefit of the patient.” 

“It is really mind-boggling what we see in our hospitals today,” said Janice Ivers, dean of nursing at National Park College in Hot Springs. “The Baby Boomers are on the brink of retirement and the Millennials and younger embrace change and move on.” 

Each nurse brings to the profession a unique set of values. Martha Chamness, UAMS

This co-mingling of life experiences, training methodology and individual backgrounds have fundamentally changed the nursing environment, said Brinda McKinney, RN, MSN, PhD , assistant professor of nursing and RN-BSN program coordinator at Arkansas State University in Jonesboro College of Nursing and Health Professions.

“No longer do nurses work only with a group of like peers and take care of a group of patients from their community that are also like them,” she said. “Just as patients are reflective of a more diverse population, nursing teams have become increasingly diverse in several ways.

“Nurses may work on teams ranging from age 20 to 75. Having nurses from six decades working together for the common good of the patient requires good communication, professional collaboration and mutual respect.”

The first challenge of the new nursing workplace is understanding how each group views their job responsibilities and by extension, each other. 

“Older nurses bring stability and experience to the arena. They have seen it and done it, they know what works and what doesn’t,’ Ivers said. “Older generations have better work ethic, being on time, not calling in compared to the younger group, but sometimes they are not willing to step outside of their comfort zone.

“The younger nurses come in excited and know what the book says, but they have not seen it or done it. They sometimes are influenced by the nurses that use shortcuts to do the right thing the wrong way. Simple communication is difficult for some younger generations; in the age of texting they tend to hesitate with verbal communication.”

Ironically, what the profession sees as multi-generational challenges presents advantages for the patient, such as being served by someone they can relate to and the experience-driven checks and balances that emerge in teams.

“Having a more experienced nurse to go to if there is a problem is very relieving because you know that nurse is going to be able to help you with your problem or find someone who can help,” said Tara Culbreath, newly graduated from Jefferson Regional Medical Center School of Nursing in Pine Bluff. 

“It’s always nice to have someone who is more experienced lend a helping hand or answer a question you may have. It’s also nice to have an extra set of eyes to take a look at a patient that you feel needs intervention but you’re not sure what step to take next.”

“Each nurse brings to the profession a unique set of values that make them who they are and all have certain standards that must be applied for proper care. I could line up four nurse angels who I would want to care for me or mine in the hospital and they are so very different,” said Martha Chamness, RN, MNSC, CPHQ (retired), now a volunteer at UAMS.  

Steve Davis, RN, of UAMS shares a laugh with a patient.

“The strength of the older nurse is communication with the physicians and older patients; the experiences older nurses contribute are phenomenal. They are more willing to work as a group to solve problems. Younger nurses bring a freshness to the workplace. They have new ideas and aren’t afraid of voicing their opinions.”

In addition to age and ethnic background, gender also figures into the equation as never before. More men are entering the field, many of whom are taking the non-traditional route to nursing school and schools in turn are going out of their way to attract men and non-traditional students as a means of keeping up with market demand.

“Arkansas State Mountain Home School of Health Sciences offers degree options for students in any stage of life,” said Derek Scott, 36. “Non-traditional students are the norm here, not the exception. I’m a veteran, I’m a father and I’m a husband. You can transition from the military, you can transition from other schools and they make you feel at home here.”

Meshing the various skills, abilities and points of view doesn’t happen all by itself. Bringing generations, genders and cultures together takes trial and error. 

UALR students reflect the diversity of backgrounds currently found in the nursing profession today.

“Being a good manager of a multi-generational nursing team requires the ability to communicate in different ways,”said Lizz Garbett, RN, director of nursing at Youth Home. “You have to have the ability to make sure everyone on the team understands what is expected of them and knows that their role is important.

Garbett said the number of nurses staying longer on the job has grown over the past 15 years, thanks to high demand for nursing expertise. She said supervising nurses years her senior requires multiple modes of communication. It’s also helped her and other supervisors appreciate and utilize the unique attributes of each age category.

“For nurses 50+, the strengths are they’re steady and dependable, skilled and they can mentor and provide role models. Their relative weakness is technology,” said Steve Davis, RN at UAMS. “Nurses 30 to 50 usually have good experience and are better with technology. 

“Younger nurses, 20 to 30, are excellent with electronic medical records, are up-to-date on health care reform since it has happened while they were training and in school and they’re eager to learn.”

Each group generally appreciates cross-generational skills, but mutual respect takes time to develop. Much of this is understandable, considering how radically the profession has changed.

“Today’s workplace for nurses is very different than that of generations gone by,” said McKinney. “Day-to-day operations on a typical nursing floor have changed significantly as new equipment and technologies have allowed nurses to expand their practice. 

“Advanced nursing education has also allowed nurses to grow their influence. Arkansas State (Jonesboro) has state-of-the-art laboratories with faculty specifically trained in life-like simulations where students practice in very intense scenarios without fear of hurting anyone.” 

Such training is only one element of the encroachment of technology on the nursing field, thanks to various gadgets and systems which provide tighter controls on patient information and speeds communication.

“The range of technology for nursing pretty much covers the entire spectrum of what nurses do on a daily basis,” said Ashley Davis, clinical instructor and academic coach at UAMS. “Electronic medical records have replaced patient medical charts, and can vary greatly in style and function between institutions and even nursing units. Electronic medication systems have replaced buddy checks between nurses and have limited a nurse’s autonomy with regards to medication administration.”

Technological advancements and protocols, while resulting in better outcomes and greater productivity among medical personnel, can also be intimidating for generations used to paper. Managed properly, however, the technological comfort gap can also be a source of bonding between nurse generations. 

“With regard to nurses’ ease with technology, the younger generation seems more at ease and quicker to take it up,” Davis said. “However, one could argue it is the older generation that best integrates technology into practice for they are better able to find the balance between technology and the healing touch.”

“I have always said that nursing care does not change, it is the gadgets we hook up to them,” agreed Chamness. “(Author) Patricia Benner explains nursing from novice to expert and how each communicates. The expert nurse sees and interprets patient behavior from experience. That patient looks funny but you can’t tell the novice how to come to that conclusion. That’s why it’s best to orient a new graduate with someone who has been nursing around five years and then spend time with the veteran.”

Beyond age, the ranks of minority nurses are also increasing, Hispanic in particular, but also African American, Asian and other ethnic populations. Blending different backgrounds can be complicated by cultural perspectives.

“Nursing is a multi-cultural workplace. Thankfully people from all walks of life and all ethnic backgrounds are entering the field of nursing,” McKinney said. “Having a diverse nursing population that resembles the local population is advantageous to health care organizations. However, management must take into account the different cultures and provide support and education for the nursing team members to be integrated.”

“With health care being such a multi-cultural field across all disciplines, cultural awareness and cultural competence becomes crucial for nursing,” said Shankar Kathiresan, RN with UAMS. “This applies to health care professionals as well as patients and their families. With nursing schools preparing nurses for career advancement, the managerial opportunities and challenges could be geared towards maintaining balanced staff matrixes.”

Kathiresan also noted employers are starting to seek higher levels of credentials from nurses and as younger nurses jump at these opportunities, combined with waves of Baby Boomers growing older, the challenges of combining different ages, level of experience and ethnic background aren’t likely to subside any time soon. 

“Many nurses are now planning to obtain their Master’s degree in nursing even before they have finished their Bachelor’s degree program,” she said. “This could potentially mean large groups of new graduates could be entering the acute bedside workforce together but then leaving together after they obtain their Master’s degree to pursue other career opportunities. This could affect attempts to balance staffing matrixes based on years of experience.”

Older individuals have their own motivations for staying in the profession longer, that go beyond the rosy job market.  

“Nurses are staying on the job longer because of economic necessity, uncertainty about retirement benefits and the passion for the work they perform as a nurse,” said Nancy May, RN, with Jefferson Regional Medical Center. 

“Many nurses are returning to the workplace after raising their children, caring for loved ones or to try a different job in the nursing career. There is a great demand for nurses in many specialties and in many parts of the country. For many, the time is right to return to work in the nursing field while demand is high.”

To help facilitate this, many nursing schools are seeing an influx of people getting a later start on a nursing education as well as seeing the occasional veteran nurse return to get caught up on newer materials, particularly with the rise of online courses and specialized training courses. 

“Over the last five years, special review courses have been developed for nurses who left the work force and are seeking re-entry,” said Wendy Lincoln MSN, BSN, RN, NEA-BC, assistant vice president of Med/Surg for Baptist Health Little Rock. “Most nurses who have not been working in the last three to five years find this very helpful, because so many things have changed, not only the technology, but also advances in the way we take care of our patients.  

“For example, five years ago if you walked into an ICU, every patient had a urinary catheter in place and most likely it was not removed until right before the patient went home. Today, only the patients who have a distinct clinical need have a urinary catheter in place and it is reviewed every day to see if can be removed.”

Nurses who have left the field may also find the new environment too physically taxing with longer shifts and the strength it requires to shift or move patients. This leads some to volunteer and others, like Candy Conners, RN, MNSc, to work on an as-needed basis. Conners, who entered the nursing field in 1971, today fills in sporadically as part of UAMS’ PRN pool. 

“I work an average of 10 hours or so a week; some weeks I don’t work at all and sometimes I work 40 hours a week,” she said. “Being in the PRN pool means I have the flexibility to travel and enjoy retirement while still being a part of UAMS.”

Serving so long in the profession (she actually retired once, in 2013) has given her a rewarding career, lifelong friends and colleagues and most of all, perspective. 

“I enjoy seeing the ‘old’ and ‘young’ nurses working together. This injects new ideas, wisdom, efficiency and a fresh look into today’s nursing climate,” she said. “Each member of the team makes contributions in their own unique way when the manager takes the time and effort to learn the strengths and weakness of each generation. When it works, as it does on many units, patient care flows naturally and seamlessly leading to patient and staff satisfaction.”

Nursing Notes

“I think the different generations could work to share different communications styles with each other. As a member of the Baby Boomers generation, I prefer to communicate in person, whereas many Millennials would rather communicate electronically. In any workplace, being on the same page is incredibly important and without good communication with each other it can be nearly impossible.”


Floyd Eddie Carter Nurse Recruiter, Arkansas DHS
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