Team concepts
Improve the function of multigenerational teams By Mark Douglas, MSN, RN, NEA-BC; Tim Howell, MSN, RN, CENP; Elaine Nelson, MSN, RN, NEA-BC; Laurel Pilkington, MSN, RN, CCRN, CPEN; and Irene Salinas, MSN, RN
T
he age-groups of nurses are always changing. The U.S. Department of Health and Human Services recent nursing workforce report indicates that generation X has overtaken the baby boomers. Generation X now comprises 39% of the nursing workforce; baby boomers, 32%; generation Y, 26%; and traditionalists, 2.6%. Although generation X is now the predominant age-group, generation Y is expected to be 50% of the nursing workforce by 2020.1 Each generation brings characteristics, strengths, and needs to the team. (See Table 1.) When working with multigenerational teams, the challenge is to capitalize on the knowledge of each generation. Understanding what motivates and challenges team members can assist the nurse leader in preventing team dysfunction. The five dysfunctions of a team Five factors that interfere with creating solid, effective teams have been identified.2 Known as the five dysfunctions, each element affects and can be affected by generational differences. Absence of trust When team trust exists, team members are willing to admit mistakes, share their weaknesses, and express their concerns without fear of retaliation.3 Recognizing and understanding how to overcome generational trust issues is paramount to developing a successful and functioning team. Team members can overcome individual trust issues and build team trust by asking each other for help, giving feedback and offering assistance, www.nursingmanagement.com
and recognizing all team members’ experiences and skills.3 Fear of conflict Team members who trust each other have overcome the fear of conflict and are free to express their opinions and have more comprehensive discussions.4 If a team avoids conflict, it can lead to frustration and eventually a decision to tolerate team members rather than trust them. This behavior erodes team cohesion.4 Highly functioning multigenerational teams have an understanding of generational tendencies and take measures to establish ground rules that recognize conflict as constructive. Lack of commitment Dysfunctional teams lack commitment to the decisions being made. The cost of a lack of commitment can be high, resulting in active or passive sabotage, frustration, and failure. Failure to commit may result in excessive analysis and unnecessary delay, a lack of confidence, fear of failure, and second-guessing among team members. Even well-performing teams can struggle with commitment when they fall short of arriving at specific agreements at the end of their discussion.4 When there’s a lack of commitment, unclear accountability results. Avoidance of accountability The objective of any team is to work together to complete a goal. Avoidance of accountability jeopardizes reaching the goal and attaining results. Every team member must hold themselves accountable for their own actions and input. Although holding the other team members accountable for their actions can be intimidating, peer-to-peer accountability is the most successful way for a team to be healthy and productive.4 Inattention to results The key cause of inattention to results is team members putting their individual needs above the team’s goals.2 This can happen if team members desire Nursing Management • January 2015 11
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Team concepts career advancement or personal recognition. Inattention to results impacts outcomes-based performance. Team members who trust one another engage in conflict and conflict management. They commit to decisions and hold one another accountable. The team is put above one’s self.2 Strategies to improve team function Nurse leaders are challenged by the complexity of teams and the influence of a multigenerational workforce on teamwork. Following team improvement strategies can help
nurse leaders support team function. (See Table 2.) Establish a team agreement Creating a safe environment of inclusion and mutual respect for each generation is critical when striving for team cohesion. Multigenerational team members may view commitment in different ways and have different perspectives about what this means on a personal level. Utilizing a formal signed agreement can communicate the expectation of respect for and consideration of all perspectives.3 This helps each generation
Table1: Generational definitions Year born
Age in 2014 (years)
Characteristics
Traditionalists
1937 to 1945
69 to 77
• Loyal • Respectful • Rule followers
Baby boomers
1946 to 1964
50 to 68
• Competitive • Strong work ethic • Enjoy recognition • Enjoy group work
Generation X
1965 to 1977
38 to 49
• Individualistic • Self-accountability • Challenge status quo
Generation Y (Millennials)
1978 to present
16 (able to legally work) to 37
• Need immediate feedback • Goal oriented • Not afraid to ask questions • Technology savvy
Source: Adapted from Bell JA. Five generations in the nursing workforce: implications for nursing professional development. J Nurses Prof Dev. 2013;29(4):205-210.
Table 2: Team improvement strategies3,4,7 Establish a team agreement
• Create a safe environment. • Use a formal signed agreement. • Establish accountability.
Provide one-on-one coaching
• Address individual needs. • Acknowledge that each generation’s coaching needs are unique. • Employ real-time feedback.
Conduct a communication workshop
• Help team members understand different ways to effectively communicate. • Be available in class or online formats.
Probe for conflict
• Remember that silence suggests agreement. • Facilitate a safe environment for debate. • Mine for conflict. • Seek real-time permission to engage in conflict.
Recognize results
• Generate enthusiasm. • Create a culture of appreciation.
12 January 2015 • Nursing Management
understand that a difference of opinion isn’t a lack of respect, but rather an expectation. The formal agreement can solidify a unified commitment and help establish accountability. When developing a team agreement, points to start with include: • taking inventory of issues that team members find disruptive • developing positive statements of behavior instead of negativity • using personal words such as “I” instead of terms such as “team members” • including an actual statement of agreement • requiring the signatures of all team members acknowledging the agreement. Moving forward with the agreement includes: • starting every meeting with a reminder of the agreement • discussing agreement components not being followed • acknowledging strengths that the team is exhibiting by living the agreement.5 Provide one-on-one coaching Coaching may be necessary to improve team functioning and progress toward your goals. The best coaching typically takes place on a one-on-one basis and is a way to help team members make the best use of their individual capabilities.6 Different styles of one-on-one coaching facilitate meeting the overall needs of the team and promote team engagement. Generation X and Y team members have grown up with parents as coaches and are open to being coached by more mature and experienced individuals willing to share personal experiences, wisdom, and knowledge.6,7 For the independent minded generation X, a key strategy is active listening and observation techniques because these team members prefer opportunities to demonstrate their own expertise and should be given ample time to www.nursingmanagement.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Team concepts do so.6 Generation Y, on the other hand, requires more personalized feedback and coaching.6 Baby boomers prefer a coach who’s seen as a peer because they prefer peer-topeer interaction. For traditionalists, seniority-based one-on-one coaching with detailed instructions on how to improve their individual performance is a good option.6 Conduct a communication skills workshop Providing education to enhance communication skills can help achieve team cohesion. Whether onsite or as web-based training, focusing on multigenerational cohorts provides an understanding of the generational tendencies of team members. Training can include exercises on generational self-discovery and discussion of ways to communicate with teams of different generational backgrounds. For the younger generation, web-based training is a plus because they value their off time. Short presentation sessions (15 minutes) followed by interactivity allow all generations to effectively learn the content and how it can be applied. Case presentations, roleplaying, and video vignettes can be used to engage team members of different generations.3 Probe for conflict The team leader can announce silence as a vote of agreement. This tactic may provoke input from those who are reluctant to state a difference of opinion. In addition, team leaders can acknowledge conflict when it’s happening and point out the benefits of understanding different perspectives.4 Although the team may understand the importance of conflict, it may still be difficult to get team members to engage in healthy conflict.4 One effective strategy for leaders is mining for conflict.4 The team leader exposes disagreements that haven’t yet surfaced. The team www.nursingmanagement.com
members are able to express concerns and unproductive postmeeting conversations can be avoided. Another strategy for encouraging conflict during a team meeting is real-time permission. When the team leader sees the team engaging in disagreement, the leader interrupts the meeting and reinforces to the team that conflict is healthy.4 This gives the team members permission to release the guilt involved with disagreeing and reminds them that they’re helping and not hurting the team.4 Recognize results Giving recognition for contributions and results is universally a solid strategy.4 Recognition for progress along the way helps the team generate the energy and determination needed to maintain advancement. One simple and effective tool to recognize others is a personal handwritten note of gratitude. These notes can be sent to the home or the working department of the team member. A prominent display of performance outcomes is also useful to recognize results. Public recognition by the leader shows gratitude for performance and is highly effective. Having recognition as the first agenda item during a staff meeting can be a reminder for the leader to publicly recognize performances and set a tone of appreciation. Regardless of the generation, recognition for performance builds confidence and keeps spirits high through complex processes.2 Although rewarding the team versus individuals strengthens the team, accommodating generation-specific rewards, to recognize performance is also a useful strategy.3 Traditionalists and baby boomers value monetary rewards, whereas generation X and Y usually place more value on time off. However, if the current compensation is thought to be adequate, genuine leader appreciation is the fuel needed.4
Solutions for the future The five dysfunctions of a team can be made more challenging by generational differences. Understanding the interaction among generations, what makes teams dysfunctional, and strategies for enhancing performance affords nurse leaders insight into team function, ultimately improving team output. Your understanding of multigenerational teams can boost team functioning and benefit patients and families by seeking improved solutions for healthcare. NM
REFERENCES 1. Department of Health and Human Services. The U. S. nursing workforce: trends in supply and education. http://bhpr.hrsa. gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf. 2. Lencioni P. The Five Dysfunctions of a Team: A Leadership Fable. San Francisco, CA: Jossey-Bass; 2002. 3. Gallo AM. Beyond the classroom: using technology to meet the educational needs of multigenerational perinatal nurses. J Perinat Neonatal Nurs. 2011;25(2):195-199. 4. Lencioni P. The Advantage: Why Organizational Health Trumps Everything Else in Business. San Francisco, CA: Jossey-Bass; 2012. 5. Yoder-Wise P, Kowalski K. Transforming team practice through the use of agreements. American Organization of Nurse Executives 46th Meeting and Exhibition, Denver, CO, March 22, 2013. 6. Hendricks JM, Cope VC. Generational diversity: what nurse managers need to know. J Adv Nurs. 2013;69(3):717-725. 7. Hahn JA. Managing multiple generations: scenarios from the workplace. Nurs Forum. 2011;46(3):119-127. Mark Douglas is an administrative nursing supervisor at Baptist Hospitals of Southeast Texas in Beaumont Tex. Tim Howell is the senior vice president of Patient Care Services at University Medical Center in Lubbock, Tex. Elaine Nelson is the chief nursing officer at Texas Health Harris Methodist Fort Worth in Fort Worth, Tex. Laurel Pilkington is a nursing professional development specialist III and a clinical educator at McLane Children’s Hospital in Temple, Tex. Irene Salinas is an assistant professor at Texas Tech Health Sciences Center School of Nursing in Lubbock, Tex. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000459098.71482.c4
Nursing Management • January 2015 13
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Improve the function of multigenerational teams By Mark Douglas, MSN, RN, NEA-BC; Tim Howell, MSN, RN, CENP; Elaine Nelson, MSN, RN, NEA-BC; Laurel Pilkington, MSN, RN, CCRN, CPEN; and Irene Salinas, MSN, RN
T
he age-groups of nurses are always changing. The U.S. Department of Health and Human Services recent nursing workforce report indicates that generation X has overtaken the baby boomers. Generation X now comprises 39% of the nursing workforce; baby boomers, 32%; generation Y, 26%; and traditionalists, 2.6%. Although generation X is now the predominant age-group, generation Y is expected to be 50% of the nursing workforce by 2020.1 Each generation brings characteristics, strengths, and needs to the team. (See Table 1.) When working with multigenerational teams, the challenge is to capitalize on the knowledge of each generation. Understanding what motivates and challenges team members can assist the nurse leader in preventing team dysfunction. The five dysfunctions of a team Five factors that interfere with creating solid, effective teams have been identified.2 Known as the five dysfunctions, each element affects and can be affected by generational differences. Absence of trust When team trust exists, team members are willing to admit mistakes, share their weaknesses, and express their concerns without fear of retaliation.3 Recognizing and understanding how to overcome generational trust issues is paramount to developing a successful and functioning team. Team members can overcome individual trust issues and build team trust by asking each other for help, giving feedback and offering assistance, www.nursingmanagement.com
and recognizing all team members’ experiences and skills.3 Fear of conflict Team members who trust each other have overcome the fear of conflict and are free to express their opinions and have more comprehensive discussions.4 If a team avoids conflict, it can lead to frustration and eventually a decision to tolerate team members rather than trust them. This behavior erodes team cohesion.4 Highly functioning multigenerational teams have an understanding of generational tendencies and take measures to establish ground rules that recognize conflict as constructive. Lack of commitment Dysfunctional teams lack commitment to the decisions being made. The cost of a lack of commitment can be high, resulting in active or passive sabotage, frustration, and failure. Failure to commit may result in excessive analysis and unnecessary delay, a lack of confidence, fear of failure, and second-guessing among team members. Even well-performing teams can struggle with commitment when they fall short of arriving at specific agreements at the end of their discussion.4 When there’s a lack of commitment, unclear accountability results. Avoidance of accountability The objective of any team is to work together to complete a goal. Avoidance of accountability jeopardizes reaching the goal and attaining results. Every team member must hold themselves accountable for their own actions and input. Although holding the other team members accountable for their actions can be intimidating, peer-to-peer accountability is the most successful way for a team to be healthy and productive.4 Inattention to results The key cause of inattention to results is team members putting their individual needs above the team’s goals.2 This can happen if team members desire Nursing Management • January 2015 11
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Team concepts career advancement or personal recognition. Inattention to results impacts outcomes-based performance. Team members who trust one another engage in conflict and conflict management. They commit to decisions and hold one another accountable. The team is put above one’s self.2 Strategies to improve team function Nurse leaders are challenged by the complexity of teams and the influence of a multigenerational workforce on teamwork. Following team improvement strategies can help
nurse leaders support team function. (See Table 2.) Establish a team agreement Creating a safe environment of inclusion and mutual respect for each generation is critical when striving for team cohesion. Multigenerational team members may view commitment in different ways and have different perspectives about what this means on a personal level. Utilizing a formal signed agreement can communicate the expectation of respect for and consideration of all perspectives.3 This helps each generation
Table1: Generational definitions Year born
Age in 2014 (years)
Characteristics
Traditionalists
1937 to 1945
69 to 77
• Loyal • Respectful • Rule followers
Baby boomers
1946 to 1964
50 to 68
• Competitive • Strong work ethic • Enjoy recognition • Enjoy group work
Generation X
1965 to 1977
38 to 49
• Individualistic • Self-accountability • Challenge status quo
Generation Y (Millennials)
1978 to present
16 (able to legally work) to 37
• Need immediate feedback • Goal oriented • Not afraid to ask questions • Technology savvy
Source: Adapted from Bell JA. Five generations in the nursing workforce: implications for nursing professional development. J Nurses Prof Dev. 2013;29(4):205-210.
Table 2: Team improvement strategies3,4,7 Establish a team agreement
• Create a safe environment. • Use a formal signed agreement. • Establish accountability.
Provide one-on-one coaching
• Address individual needs. • Acknowledge that each generation’s coaching needs are unique. • Employ real-time feedback.
Conduct a communication workshop
• Help team members understand different ways to effectively communicate. • Be available in class or online formats.
Probe for conflict
• Remember that silence suggests agreement. • Facilitate a safe environment for debate. • Mine for conflict. • Seek real-time permission to engage in conflict.
Recognize results
• Generate enthusiasm. • Create a culture of appreciation.
12 January 2015 • Nursing Management
understand that a difference of opinion isn’t a lack of respect, but rather an expectation. The formal agreement can solidify a unified commitment and help establish accountability. When developing a team agreement, points to start with include: • taking inventory of issues that team members find disruptive • developing positive statements of behavior instead of negativity • using personal words such as “I” instead of terms such as “team members” • including an actual statement of agreement • requiring the signatures of all team members acknowledging the agreement. Moving forward with the agreement includes: • starting every meeting with a reminder of the agreement • discussing agreement components not being followed • acknowledging strengths that the team is exhibiting by living the agreement.5 Provide one-on-one coaching Coaching may be necessary to improve team functioning and progress toward your goals. The best coaching typically takes place on a one-on-one basis and is a way to help team members make the best use of their individual capabilities.6 Different styles of one-on-one coaching facilitate meeting the overall needs of the team and promote team engagement. Generation X and Y team members have grown up with parents as coaches and are open to being coached by more mature and experienced individuals willing to share personal experiences, wisdom, and knowledge.6,7 For the independent minded generation X, a key strategy is active listening and observation techniques because these team members prefer opportunities to demonstrate their own expertise and should be given ample time to www.nursingmanagement.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Team concepts do so.6 Generation Y, on the other hand, requires more personalized feedback and coaching.6 Baby boomers prefer a coach who’s seen as a peer because they prefer peer-topeer interaction. For traditionalists, seniority-based one-on-one coaching with detailed instructions on how to improve their individual performance is a good option.6 Conduct a communication skills workshop Providing education to enhance communication skills can help achieve team cohesion. Whether onsite or as web-based training, focusing on multigenerational cohorts provides an understanding of the generational tendencies of team members. Training can include exercises on generational self-discovery and discussion of ways to communicate with teams of different generational backgrounds. For the younger generation, web-based training is a plus because they value their off time. Short presentation sessions (15 minutes) followed by interactivity allow all generations to effectively learn the content and how it can be applied. Case presentations, roleplaying, and video vignettes can be used to engage team members of different generations.3 Probe for conflict The team leader can announce silence as a vote of agreement. This tactic may provoke input from those who are reluctant to state a difference of opinion. In addition, team leaders can acknowledge conflict when it’s happening and point out the benefits of understanding different perspectives.4 Although the team may understand the importance of conflict, it may still be difficult to get team members to engage in healthy conflict.4 One effective strategy for leaders is mining for conflict.4 The team leader exposes disagreements that haven’t yet surfaced. The team www.nursingmanagement.com
members are able to express concerns and unproductive postmeeting conversations can be avoided. Another strategy for encouraging conflict during a team meeting is real-time permission. When the team leader sees the team engaging in disagreement, the leader interrupts the meeting and reinforces to the team that conflict is healthy.4 This gives the team members permission to release the guilt involved with disagreeing and reminds them that they’re helping and not hurting the team.4 Recognize results Giving recognition for contributions and results is universally a solid strategy.4 Recognition for progress along the way helps the team generate the energy and determination needed to maintain advancement. One simple and effective tool to recognize others is a personal handwritten note of gratitude. These notes can be sent to the home or the working department of the team member. A prominent display of performance outcomes is also useful to recognize results. Public recognition by the leader shows gratitude for performance and is highly effective. Having recognition as the first agenda item during a staff meeting can be a reminder for the leader to publicly recognize performances and set a tone of appreciation. Regardless of the generation, recognition for performance builds confidence and keeps spirits high through complex processes.2 Although rewarding the team versus individuals strengthens the team, accommodating generation-specific rewards, to recognize performance is also a useful strategy.3 Traditionalists and baby boomers value monetary rewards, whereas generation X and Y usually place more value on time off. However, if the current compensation is thought to be adequate, genuine leader appreciation is the fuel needed.4
Solutions for the future The five dysfunctions of a team can be made more challenging by generational differences. Understanding the interaction among generations, what makes teams dysfunctional, and strategies for enhancing performance affords nurse leaders insight into team function, ultimately improving team output. Your understanding of multigenerational teams can boost team functioning and benefit patients and families by seeking improved solutions for healthcare. NM
REFERENCES 1. Department of Health and Human Services. The U. S. nursing workforce: trends in supply and education. http://bhpr.hrsa. gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf. 2. Lencioni P. The Five Dysfunctions of a Team: A Leadership Fable. San Francisco, CA: Jossey-Bass; 2002. 3. Gallo AM. Beyond the classroom: using technology to meet the educational needs of multigenerational perinatal nurses. J Perinat Neonatal Nurs. 2011;25(2):195-199. 4. Lencioni P. The Advantage: Why Organizational Health Trumps Everything Else in Business. San Francisco, CA: Jossey-Bass; 2012. 5. Yoder-Wise P, Kowalski K. Transforming team practice through the use of agreements. American Organization of Nurse Executives 46th Meeting and Exhibition, Denver, CO, March 22, 2013. 6. Hendricks JM, Cope VC. Generational diversity: what nurse managers need to know. J Adv Nurs. 2013;69(3):717-725. 7. Hahn JA. Managing multiple generations: scenarios from the workplace. Nurs Forum. 2011;46(3):119-127. Mark Douglas is an administrative nursing supervisor at Baptist Hospitals of Southeast Texas in Beaumont Tex. Tim Howell is the senior vice president of Patient Care Services at University Medical Center in Lubbock, Tex. Elaine Nelson is the chief nursing officer at Texas Health Harris Methodist Fort Worth in Fort Worth, Tex. Laurel Pilkington is a nursing professional development specialist III and a clinical educator at McLane Children’s Hospital in Temple, Tex. Irene Salinas is an assistant professor at Texas Tech Health Sciences Center School of Nursing in Lubbock, Tex. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000459098.71482.c4
Nursing Management • January 2015 13
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
