PERIOPERATIVE LEADERSHIP Recruiting and Retaining Generation Y Perioperative Nurses ROSE O. SHERMAN, EdD, RN, NEA-BC, FAAN
T
he future of perioperative nursing will be in the hands of Generation Y (ie, Millennial) nurses by the beginning of the next decade. With three million Baby Boomers turning 65 years of age each year for the next 20 years (ie, from 2015 to 2035), it is anticipated that Generation Y will comprise 50% of the nursing workforce by 2020.1 Demographic transformations have been described as dramas in slow motion, because they unfold incrementally before the aha moment suddenly reveals that the world has changed.2 This is likely to happen in the perioperative nursing workforce and will affect succession planning. Perioperative nurse leaders and personnel working in the surgical area are older than nurses in other specialty areas.3 As noted in recent research published in Health Affairs, historical patterns for nursing retirements have changed during the past two decades: 74% of nurses are working at 62 years of age and 24% at 69 years of age.4 Perioperative nursing has benefited from these trends, but at some point these nurses will begin to retire in significant numbers. Recruitment to replace retiring perioperative nurses is expected to be challenging. During the past three decades, few nurses have been exposed to perioperative nursing during their education programs, resulting in unique problems in the recruitment of younger personnel.5 In recent research
conducted with perioperative nurse leaders, 55.8% of respondents reported that they currently experience difficulty recruiting personnel, and 67.9% reported that they anticipate finding qualified nurses to hire will be problematic within five years.6 Learning how to effectively recruit, motivate, lead, and nurture Generation Y nurses will be critical for the future of perioperative nursing. Nurse leaders will not be able to opt out of managing this generation of nurses. This report provides an overview of what is known about Generation Y based on the research and literature and provides guidance for leaders on recruitment and retention. WHO IS GENERATION Y? The Generation Y cohort was born between 1980 and 2000. They have been raised during an unusual time when life in general became less secure and predictable. Many of their parents responded by closely nurturing and affirming them both at home and in their education. Sometimes described as “helicopter parents,” they took a very active interest in the lives of their children, and their parenting style often included telling them how special they are and proudly displaying their child’s academic achievements on the bumpers of their cars.7 This generation was quite involved in after-school activities and team sports. In Not Everyone Gets a
The AORN Journal is seeking contributors for the Perioperative Leadership column. Interested authors can contact Cynthia Plonien, column coordinator, by sending topic ideas to [email protected]. http://dx.doi.org/10.1016/j.aorn.2014.10.006
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Ó AORN, Inc, 2015
PERIOPERATIVE LEADERSHIP Trophy: How to Manage Generation Y, author Bruce Tulgan points out that it was during the childhoods of Generation Y that trophy awards for simple participation on a team became common.8 During their school years, volunteer activities were expected, and Generation Y is civic minded as an outcome of these experiences. They were also the first generation who were educated to be concerned about the sustainability of the environment. Uncertainty in the workplace has always been part of what they observed with their parents, so they have come to expect that frequent career changes may be the norm in their lives. Work futurists have observed that Generation Y is well suited to adapt to some of the forces shaping work today, including technological advances, an increase in multiculturalism, and globalization.9 This generation has been noted by researchers to be the most globally connected of all generations and accepts multiculturalism as a way of life.7,10,11 For the Millennials, technology and instant communication by cell phone has always been a way of life. Although empirical evidence to validate generational differences is limited, many factors other than membership in a generational cohort influence their values, attitudes, and behaviors. These include but are not limited to ethnicity, environment, religion, and socioeconomic status of members of their generation.1 Some authors believe that most differences seen in generational cohorts are more attributable to life stage than to true generational differences.10-16 Table 1 outlines the characteristics that have been attributed to Generation Y in the literature.11-16 WHAT MATTERS TO GENERATION Y NURSES? As a generational cohort, Generation Y entered nursing at an earlier age than did Generation X. This Millennial generation is largely responsible for the significant growth seen in the RN workforce during the past decade,17 and these nurses may have long professional careers. Recent evidence suggests that they are more satisfied with their
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TABLE 1. Characteristics of Generation Y 1-6 Nurses n n n n n n n n n n n n n n n n n n n n n n n n
Demonstrates cyber-literacy Does not like hierarchy Does not read in the same way as other generations Does not want to pay dues to advance up the career ladder Embraces change Enjoys community service Experiences higher levels of psychological stress Identifies themselves as leaders at an earlier age Is able to multitask Is confident about abilities Is self-absorbed Is sensitive about work criticism Is tolerant of diversity Is willing to make a job change if expectations are not met Likes group work and win-win environments Likes safety and security Needs clear directions on assignments Not in awe of authority figures Not used to planning ahead Seeks coaching as a vital need Seeks interesting and meaningful work Seeks work/life flexibility and balance Seeks recognition for their accomplishments Wants challenge but not traditional responsibility
References 1. Espinoza C, Ukleja M, Rusch C. Managing the Millennials. New York: Wiley & Sons; 2010. 2. Deloitte Millennial Survey (January 2014). Big Demands and High Expectations: What Generation Y Wants from Business, Government and the Workplace. http://www.deloitte.com/view/en_NZ/nz/ news-room/7a23840dda1b3410VgnVCM2000003356f70aRCRD .htm. Accessed September 30, 2014. 3. Meister JC, Willyerd K. The 2020 Workplace: How Innovative Companies Attract, Develop, and Keep Tomorrow’s Employees Today. New York: HarperCollins; 2010. 4. Spiegel DE. The Gen Y Handbook: Applying Relationship Leadership to Engage Millennials. New York: Select Books; 2013. 5. Pulte L. Generations in the workplace. Hosp Health Net. January 2013. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath¼ HHNMAG/Article/data/01JAN2013/0113HHN_coverstory&domain¼ HHNMAG. Accessed September 30, 2014. 6. The Millennials: a portrait of Generation Next. Pew Research Center Report. February 2010. http://pewsocialtrends.org/assets/pdf/ millennials-confident-connected-open-to-change.pdf. Accessed September 30, 2014.
career choice than are other generations and more likely to recommend nursing to others.18 Although their beliefs and values may not be different from other cohorts at a similar point in their development, Generation Y nurses demonstrate two compelling AORN Journal j 139
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differences in behavior from the generations of nurses who preceded them: n
incorporation of technology as a “sixth sense” and a means of interacting with the world; and n expectation of organizational accommodation (which is an outgrowth of what they experienced from their nurturing parents and schools).12
PERIOPERATIVE LEADERSHIP Generation Y looks for environments that have healthy team relations. They have a low tolerance for any form of horizontal violence.20 Perioperative settings with a culture that tolerates any form of bullying will have difficulty retaining this generation of nurses.
RECRUITING GENERATION Y NURSES A unique challenge in recruiting Generation Y to With their understanding and keen acceptance of perioperative nursing is that it is a specialty that technology, these nurses have the potential to add most of them received no exposure to as part of significant value to perioperative departments in their formal nursing which sophisticated education. There are technologies are being 7 pilot projects to reinThe good news for perioperative nursing is introduced rapidly. that this could be a very attractive specialty troduce the perioperHowever, it is this to Generation Y nurses, who highly value ative curriculum to expectation of accomteamwork and enjoy working with advanced nursing education, modation that has technologies. but these efforts are proven to be chalnot widespread.6 The lenging for many good news for periperioperative nurse operative nursing is that this could be a very leaders. Perioperative leaders have noted that attractive specialty to Generation Y nurses, who before the widespread use of 12-hour shifts in highly value teamwork and enjoy working with nursing, it was easier to recruit nurses to the OR advanced technologies. with Monday through Friday schedules. In toPerioperative nurse leaders also recognize and day’s environment, the perioperative department appreciate the importance of a structured orientais one of the few areas in the hospital that requires tion and mentorship. The transition to becoming nurses to be on call for evening and weekend a skilled perioperative nurse takes time. The initial emergency procedures after already working 6 perioperative training and subsequent rotation their scheduled shifts. through the different OR specialty areas can take In the 2013 annual AORN salary survey, Bacon 3 up to 12 months.21 This commitment to training and Stewart reported that the median number of is both highly valued and a strong recruitment on-call hours worked per week was 16 and noted incentive for Generation Y nurses.1,22 that this number has remained the same across the previous seven surveys. Many younger personnel value work/life balance and see any on-call time as an infringement on their time off.19 When there is no accommodation to the call schedules, some perioperative leaders are reporting very high turnover rates for Generation Y nurses.6 These reports are consistent with the research findings that Generation Y nurses are more likely than other generational cohorts to leave positions if dissatisfied.1,10,11,13 140 j AORN Journal
THE NEED FOR FLEXIBLE LEADERSHIP To effectively manage Generation Y nurses, perioperative leaders must be willing to flex their leadership style to meet the career needs of this generation. However, it is important to recognize that being attuned to their needs does not mean that leaders should lower their expectations of performance or deviate from the outcomes and standards expected in patient care. As workforce
PERIOPERATIVE LEADERSHIP researchers Espinoza, Ukleja, and Rusch13 have explained, Generation Y personnel expect their managers to n n n n n n n n
be sensitive about work/life balance, provide space to do their jobs, listen to them, provide frequent and constructive feedback, provide career counseling and development, be an advocate for employees, ensure a fun work environment, and provide rewards for accomplishments.
The authors contend that if managers are able to meet these expectations, the “psychological contract” that they have with Generation Y will be very powerful and will go a long way in promoting retention. Research has shown that although this generation is less committed to remaining in organizations for long periods, they are highly motivated to stay in jobs when working with a cohesive team and a supportive manager.13,23,24 It is important for Generation Y nurses to feel that their leader is supportive in their career development because they seek opportunities for advancement and skill development. For instance, it is not unusual for a Generation Y nurse to ask managers about career advancement shortly after completing orientation. One aspect of leadership that many managers will find they need to customize is communication. Performance feedback is important to this generation, which is reported to stem from having a high level of anxiety and a fear of failure.25,26 Traditional modes of communication, such as written policies and e-mails, are not as effective with Generation Y. Messages need to be very clear and communicated through a variety of mechanisms, such as text messages or updates on a unit Facebook page. Additionally, perioperative leaders should never assume that they are understood by their personnel. Directives need to be unambiguous and should ensure closed-loop communication. A perioperative director recently observed in an interview that he is very specific in his communications
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with Generation Y nurses by requesting, for example, how many case carts he wants them to complete and how to report back to him on their progress.27 Managers also may need to talk through problem-solving situations by using critical thinking and “why” questions to develop in Generation Y nurses an awareness of possible outcomes from decisions they make.13 Being a flexible leader also will require setting aside any generational biases that can develop as a result of having different work experiences with different challenges and expectations. Experience bias might lead some managers to say “You don’t have the experience to advance at this time,” when a better approach to a Generation Y nurse would be to identify ways to enhance his or her professional development (eg, certifications, inservice programs, joining AORN). If leaders do not evolve or customize their management style and instead adopt the attitude that Generation Y will have to conform to their work values, they risk finding themselves unable to recruit or retain personnel. LEVERAGING STRENGTHS AND CREATING FUTURE LEADERS Diversity is a foundational element of strong perioperative teams. Generation Y nurses can bring many important strengths to perioperative departments. Their life experience has led them to become adaptable and flexible to change. They have always worked in a health care environment that is both unpredictable and complex. They are confident about their abilities to make change and seek organizations where their ideas are valued.13,20 They are optimistic and enjoy working on teams. Their creativity can lead to innovative solutions for complex problems. They can add a rich dimension to team thinking on complex problems and should be encouraged to join perioperative task forces, shared-governance councils, and other department and facility-wide committees. Their world has always been multicultural, and cultural competence is a deeply held value for most of this generation. They can be an invaluable AORN Journal j 141
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resource in looking at creative ways to educate and engage diverse patient populations. Because Generation Y is a civic-minded generation, they are perfect candidates to serve as unit representatives for community outreach activities and charitable organization events. Environmental sustainability is important to Generation Y, and they could be important cheerleaders for perioperative efforts to “go green.” Their love of technology can make them excellent reverse mentors for older perioperative team members. Although generally mentors are described as having many years of experience, the concept of reverse mentoring, where a less experienced staff member mentors a more experienced one, has been found to be especially valuable in the area of technology.7,10 This role is one that Generation Y nurses are quite comfortable in assuming because they often serve as mentors and resources to their own parents in the use of new technology. It can help foster stronger team relationships because it reinforces that different generations bring different strengths to the workplace and helps to build the confidence of Generation Y nurses. Generation Y nurses view themselves as leaders.28 With careful mentorship and nurturing, they will be excellent candidates to step into perioperative leadership roles in the future. CONCLUSION The attitudes, values, and beliefs of Generation Y nurses often challenge traditional perceptions of profession held by nursing leaders. Adaptive leaders will work hard to get beyond their experience bias to appreciate the strengths that this new generation of nurses can bring to perioperative nursing. By flexing their leadership style, nurse leaders will be the key to effectively recruiting and retaining Generation Y nurses. There is much to teach them, but it is also important to be open and curious about what drives their passion. Gloria Steinem once observed that across generations “there is as much to learn as there is to teach.”29 This is sage advice for all perioperative nurse leaders to take into the future.
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References 1. Managing an intergenerational workforce: strategies for health care transformation. American Hospital Association. http://www.aha.org/about/cpi/managing -intergenerational-workforce.shtml. Accessed September 30, 2014. 2. Taylor P. The Next America. New York: Public Affairs Press; 2014. 3. Bacon DR, Stewart KA. Results of the 2013 AORN salary and compensation survey. AORN J. 2013;98(6):569-584. 4. Auerbach DI, Buerhaus PI, Staiger DO. Registered nurses are delaying retirement, a shift that has contributed to the recent growth in the nurse workforce. Health Aff (Millwood). 2014;33(8):1474-1480. 5. Letvak S. The experience of being an older perioperative nurse. AORN J. 2003;78(4):635-649. 6. Sherman RO, Patterson P, Avitable T, Dahl J. Perioperative nurse leader perspectives on succession planning: a call to action. Nurs Econ. 2014;32(4):186-193, 203. 7. Tapscott D. Grown Up Digital: How the Net Generation Is Changing Your World. New York, NY: McGraw-Hill; 2009. http://socium.ge/downloads/komunikaciisteoria/ eng/Grown_Up_Digital_-_How_the_Net_Generation_ Is_Changing_Your_World_(Don_Tapscott).pdf. Accessed September 30, 2014. 8. Tulgan B. Not Everyone Gets a Trophy: How to Manage Generation Y. San Francisco, CA: Jossey-Bass; 2009. 9. Gratton L. Workplace 2025dwhat will it look like? Org Dynamics. 2011;40(4):246-254. 10. Deloitte Millennial Survey (January 2014). Big Demands and High Expectations: What Generation Y Wants from Business, Government and the Workplace. http://www .deloitte.com/view/en_NZ/nz/news-room/7a23840dda 1b3410VgnVCM2000003356f70aRCRD.htm. Accessed September 30, 2014. 11. Meister JC, Willyerd K. The 2020 Workplace: How Innovative Companies Attract, Develop, and Keep Tomorrow’s Employees Today. New York: HarperCollins; 2010. 12. McCready V. Generational issues in supervision and administration. ASHA Leader. April 26, 2011. http://www .asha.org/Publications/leader/2011/110426/Generational -Issues-in-Supervision-and-Administration. Accessed September 30, 2014. 13. Espinoza C, Ukleja M, Rusch C. Managing the Millennials. New York: Wiley & Sons; 2010. 14. Spiegel DE. The Gen Y Handbook: Applying Relationship Leadership to Engage Millennials. New York: Select Books; 2013. 15. Pulte L. Generations in the workplace. Hosp Health Net. January 2013. http://www.hhnmag.com/hhnmag/jsp/article display.jsp?dcrpath¼HHNMAG/Article/data/01JAN2013/ 0113HHN_coverstory&domain¼HHNMAG. Accessed September 30, 2014. 16. The Millennials: a portrait of Generation Next. Pew Research Center Report. February 2010. http://pew socialtrends.org/assets/pdf/millennials-confident-connected -open-to-change.pdf. Accessed September 30, 2014. 17. The U.S. nursing workforce: trends in supply and educationdresults in brief. National Center for Workforce Analysis. (April 2013) http://bhpr.hrsa.gov/hea lthworkforce/reports/nursingworkforce/nursingworkforce brief.pdf. Accessed September 30, 2014.
PERIOPERATIVE LEADERSHIP 18. 2013 Survey of Registered Nurses: Generation Gap Grows as Healthcare Transforms. San Diego, CA: AMN Healthcare; 2013. http://www.amnhealthcare .com/uploadedFiles/MainSite/Content/Healthcare_ Industry_Insights/Industry_Research/2013_RNSurvey.pdf. Accessed September 30, 2014. 19. Jamieson I, Kirk R, Andrew C. Work-life balance: what Generation Y nurses want. Nurs Leader. 2013;11(3):36-39. 20. Pellico LH, Brewer CS, Kovner CT. What newly licensed registered nurses have to say about their first experiences. Nurs Outlook. 2009;57(4):194-203. 21. AORN position statement: orientation of the registered nurse and certified surgical technologist to the perioperative setting. AORN, Inc. https://www.aorn.org/TwoColumnInsert.aspx? id¼21939&terms¼Orientation%20of%20the%20registered %20nurse%20and%20surgical%20t. Accessed September 30, 2014. 22. Andrews DR. Expectations of millennial nurse graduates transitioning into practice. Nurs Admin Q. 2013;37(2): 152-159. 23. Keepnews DM, Brewer CS, Kovner CT, Shin JH. Generational differences among newly licensed registered nurses. Nurs Outlook. 2010;58(3):155-163. 24. Brunetto Y, Farr-Wharton R, Shacklock K. Communication, training, well-being and commitment across nurse generations. Nurs Outlook. 2012;60(1):7-15. 25. Lavoie-Tremblay M, Leclerc E, Marchionni C, Drevniok U. The needs and expectations of Generation Y in the workplace. J Nurs Staff Dev. 2010;26(1):2-8.
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26. Olson ME. The “Millennials”: first year in practice. Nurs Outlook. 2009;57(1):10-17. 27. Saver C. Diverse communication styles are most effective for managing multigenerational staff. OR Manager. 2013;29(6):14-17. 28. Sherman RO, Dyess SM, Hannah E, Prestia A. Succession planning for the future through an academic-practice partnership: a nursing administration master’s program for emerging nurse leaders. Nurs Admin Q. 2013;37(1): 18-27. 29. Ohrn DG, Ashby R, Steinem G. Women who changed the worlddGloria Steinem. HerStory Quotes. http:// www.goodreads.com/work/quotes/867831-herstory-women -who-changed-the-world. Accessed October 7, 2014.
Rose O. Sherman, EdD, RN, NEA-BC, FAAN, is a professor of nursing and the director of the Nursing Leadership Institute, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL. Ms Sherman has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
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he future of perioperative nursing will be in the hands of Generation Y (ie, Millennial) nurses by the beginning of the next decade. With three million Baby Boomers turning 65 years of age each year for the next 20 years (ie, from 2015 to 2035), it is anticipated that Generation Y will comprise 50% of the nursing workforce by 2020.1 Demographic transformations have been described as dramas in slow motion, because they unfold incrementally before the aha moment suddenly reveals that the world has changed.2 This is likely to happen in the perioperative nursing workforce and will affect succession planning. Perioperative nurse leaders and personnel working in the surgical area are older than nurses in other specialty areas.3 As noted in recent research published in Health Affairs, historical patterns for nursing retirements have changed during the past two decades: 74% of nurses are working at 62 years of age and 24% at 69 years of age.4 Perioperative nursing has benefited from these trends, but at some point these nurses will begin to retire in significant numbers. Recruitment to replace retiring perioperative nurses is expected to be challenging. During the past three decades, few nurses have been exposed to perioperative nursing during their education programs, resulting in unique problems in the recruitment of younger personnel.5 In recent research
conducted with perioperative nurse leaders, 55.8% of respondents reported that they currently experience difficulty recruiting personnel, and 67.9% reported that they anticipate finding qualified nurses to hire will be problematic within five years.6 Learning how to effectively recruit, motivate, lead, and nurture Generation Y nurses will be critical for the future of perioperative nursing. Nurse leaders will not be able to opt out of managing this generation of nurses. This report provides an overview of what is known about Generation Y based on the research and literature and provides guidance for leaders on recruitment and retention. WHO IS GENERATION Y? The Generation Y cohort was born between 1980 and 2000. They have been raised during an unusual time when life in general became less secure and predictable. Many of their parents responded by closely nurturing and affirming them both at home and in their education. Sometimes described as “helicopter parents,” they took a very active interest in the lives of their children, and their parenting style often included telling them how special they are and proudly displaying their child’s academic achievements on the bumpers of their cars.7 This generation was quite involved in after-school activities and team sports. In Not Everyone Gets a
The AORN Journal is seeking contributors for the Perioperative Leadership column. Interested authors can contact Cynthia Plonien, column coordinator, by sending topic ideas to [email protected]. http://dx.doi.org/10.1016/j.aorn.2014.10.006
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Ó AORN, Inc, 2015
PERIOPERATIVE LEADERSHIP Trophy: How to Manage Generation Y, author Bruce Tulgan points out that it was during the childhoods of Generation Y that trophy awards for simple participation on a team became common.8 During their school years, volunteer activities were expected, and Generation Y is civic minded as an outcome of these experiences. They were also the first generation who were educated to be concerned about the sustainability of the environment. Uncertainty in the workplace has always been part of what they observed with their parents, so they have come to expect that frequent career changes may be the norm in their lives. Work futurists have observed that Generation Y is well suited to adapt to some of the forces shaping work today, including technological advances, an increase in multiculturalism, and globalization.9 This generation has been noted by researchers to be the most globally connected of all generations and accepts multiculturalism as a way of life.7,10,11 For the Millennials, technology and instant communication by cell phone has always been a way of life. Although empirical evidence to validate generational differences is limited, many factors other than membership in a generational cohort influence their values, attitudes, and behaviors. These include but are not limited to ethnicity, environment, religion, and socioeconomic status of members of their generation.1 Some authors believe that most differences seen in generational cohorts are more attributable to life stage than to true generational differences.10-16 Table 1 outlines the characteristics that have been attributed to Generation Y in the literature.11-16 WHAT MATTERS TO GENERATION Y NURSES? As a generational cohort, Generation Y entered nursing at an earlier age than did Generation X. This Millennial generation is largely responsible for the significant growth seen in the RN workforce during the past decade,17 and these nurses may have long professional careers. Recent evidence suggests that they are more satisfied with their
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TABLE 1. Characteristics of Generation Y 1-6 Nurses n n n n n n n n n n n n n n n n n n n n n n n n
Demonstrates cyber-literacy Does not like hierarchy Does not read in the same way as other generations Does not want to pay dues to advance up the career ladder Embraces change Enjoys community service Experiences higher levels of psychological stress Identifies themselves as leaders at an earlier age Is able to multitask Is confident about abilities Is self-absorbed Is sensitive about work criticism Is tolerant of diversity Is willing to make a job change if expectations are not met Likes group work and win-win environments Likes safety and security Needs clear directions on assignments Not in awe of authority figures Not used to planning ahead Seeks coaching as a vital need Seeks interesting and meaningful work Seeks work/life flexibility and balance Seeks recognition for their accomplishments Wants challenge but not traditional responsibility
References 1. Espinoza C, Ukleja M, Rusch C. Managing the Millennials. New York: Wiley & Sons; 2010. 2. Deloitte Millennial Survey (January 2014). Big Demands and High Expectations: What Generation Y Wants from Business, Government and the Workplace. http://www.deloitte.com/view/en_NZ/nz/ news-room/7a23840dda1b3410VgnVCM2000003356f70aRCRD .htm. Accessed September 30, 2014. 3. Meister JC, Willyerd K. The 2020 Workplace: How Innovative Companies Attract, Develop, and Keep Tomorrow’s Employees Today. New York: HarperCollins; 2010. 4. Spiegel DE. The Gen Y Handbook: Applying Relationship Leadership to Engage Millennials. New York: Select Books; 2013. 5. Pulte L. Generations in the workplace. Hosp Health Net. January 2013. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath¼ HHNMAG/Article/data/01JAN2013/0113HHN_coverstory&domain¼ HHNMAG. Accessed September 30, 2014. 6. The Millennials: a portrait of Generation Next. Pew Research Center Report. February 2010. http://pewsocialtrends.org/assets/pdf/ millennials-confident-connected-open-to-change.pdf. Accessed September 30, 2014.
career choice than are other generations and more likely to recommend nursing to others.18 Although their beliefs and values may not be different from other cohorts at a similar point in their development, Generation Y nurses demonstrate two compelling AORN Journal j 139
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differences in behavior from the generations of nurses who preceded them: n
incorporation of technology as a “sixth sense” and a means of interacting with the world; and n expectation of organizational accommodation (which is an outgrowth of what they experienced from their nurturing parents and schools).12
PERIOPERATIVE LEADERSHIP Generation Y looks for environments that have healthy team relations. They have a low tolerance for any form of horizontal violence.20 Perioperative settings with a culture that tolerates any form of bullying will have difficulty retaining this generation of nurses.
RECRUITING GENERATION Y NURSES A unique challenge in recruiting Generation Y to With their understanding and keen acceptance of perioperative nursing is that it is a specialty that technology, these nurses have the potential to add most of them received no exposure to as part of significant value to perioperative departments in their formal nursing which sophisticated education. There are technologies are being 7 pilot projects to reinThe good news for perioperative nursing is introduced rapidly. that this could be a very attractive specialty troduce the perioperHowever, it is this to Generation Y nurses, who highly value ative curriculum to expectation of accomteamwork and enjoy working with advanced nursing education, modation that has technologies. but these efforts are proven to be chalnot widespread.6 The lenging for many good news for periperioperative nurse operative nursing is that this could be a very leaders. Perioperative leaders have noted that attractive specialty to Generation Y nurses, who before the widespread use of 12-hour shifts in highly value teamwork and enjoy working with nursing, it was easier to recruit nurses to the OR advanced technologies. with Monday through Friday schedules. In toPerioperative nurse leaders also recognize and day’s environment, the perioperative department appreciate the importance of a structured orientais one of the few areas in the hospital that requires tion and mentorship. The transition to becoming nurses to be on call for evening and weekend a skilled perioperative nurse takes time. The initial emergency procedures after already working 6 perioperative training and subsequent rotation their scheduled shifts. through the different OR specialty areas can take In the 2013 annual AORN salary survey, Bacon 3 up to 12 months.21 This commitment to training and Stewart reported that the median number of is both highly valued and a strong recruitment on-call hours worked per week was 16 and noted incentive for Generation Y nurses.1,22 that this number has remained the same across the previous seven surveys. Many younger personnel value work/life balance and see any on-call time as an infringement on their time off.19 When there is no accommodation to the call schedules, some perioperative leaders are reporting very high turnover rates for Generation Y nurses.6 These reports are consistent with the research findings that Generation Y nurses are more likely than other generational cohorts to leave positions if dissatisfied.1,10,11,13 140 j AORN Journal
THE NEED FOR FLEXIBLE LEADERSHIP To effectively manage Generation Y nurses, perioperative leaders must be willing to flex their leadership style to meet the career needs of this generation. However, it is important to recognize that being attuned to their needs does not mean that leaders should lower their expectations of performance or deviate from the outcomes and standards expected in patient care. As workforce
PERIOPERATIVE LEADERSHIP researchers Espinoza, Ukleja, and Rusch13 have explained, Generation Y personnel expect their managers to n n n n n n n n
be sensitive about work/life balance, provide space to do their jobs, listen to them, provide frequent and constructive feedback, provide career counseling and development, be an advocate for employees, ensure a fun work environment, and provide rewards for accomplishments.
The authors contend that if managers are able to meet these expectations, the “psychological contract” that they have with Generation Y will be very powerful and will go a long way in promoting retention. Research has shown that although this generation is less committed to remaining in organizations for long periods, they are highly motivated to stay in jobs when working with a cohesive team and a supportive manager.13,23,24 It is important for Generation Y nurses to feel that their leader is supportive in their career development because they seek opportunities for advancement and skill development. For instance, it is not unusual for a Generation Y nurse to ask managers about career advancement shortly after completing orientation. One aspect of leadership that many managers will find they need to customize is communication. Performance feedback is important to this generation, which is reported to stem from having a high level of anxiety and a fear of failure.25,26 Traditional modes of communication, such as written policies and e-mails, are not as effective with Generation Y. Messages need to be very clear and communicated through a variety of mechanisms, such as text messages or updates on a unit Facebook page. Additionally, perioperative leaders should never assume that they are understood by their personnel. Directives need to be unambiguous and should ensure closed-loop communication. A perioperative director recently observed in an interview that he is very specific in his communications
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with Generation Y nurses by requesting, for example, how many case carts he wants them to complete and how to report back to him on their progress.27 Managers also may need to talk through problem-solving situations by using critical thinking and “why” questions to develop in Generation Y nurses an awareness of possible outcomes from decisions they make.13 Being a flexible leader also will require setting aside any generational biases that can develop as a result of having different work experiences with different challenges and expectations. Experience bias might lead some managers to say “You don’t have the experience to advance at this time,” when a better approach to a Generation Y nurse would be to identify ways to enhance his or her professional development (eg, certifications, inservice programs, joining AORN). If leaders do not evolve or customize their management style and instead adopt the attitude that Generation Y will have to conform to their work values, they risk finding themselves unable to recruit or retain personnel. LEVERAGING STRENGTHS AND CREATING FUTURE LEADERS Diversity is a foundational element of strong perioperative teams. Generation Y nurses can bring many important strengths to perioperative departments. Their life experience has led them to become adaptable and flexible to change. They have always worked in a health care environment that is both unpredictable and complex. They are confident about their abilities to make change and seek organizations where their ideas are valued.13,20 They are optimistic and enjoy working on teams. Their creativity can lead to innovative solutions for complex problems. They can add a rich dimension to team thinking on complex problems and should be encouraged to join perioperative task forces, shared-governance councils, and other department and facility-wide committees. Their world has always been multicultural, and cultural competence is a deeply held value for most of this generation. They can be an invaluable AORN Journal j 141
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resource in looking at creative ways to educate and engage diverse patient populations. Because Generation Y is a civic-minded generation, they are perfect candidates to serve as unit representatives for community outreach activities and charitable organization events. Environmental sustainability is important to Generation Y, and they could be important cheerleaders for perioperative efforts to “go green.” Their love of technology can make them excellent reverse mentors for older perioperative team members. Although generally mentors are described as having many years of experience, the concept of reverse mentoring, where a less experienced staff member mentors a more experienced one, has been found to be especially valuable in the area of technology.7,10 This role is one that Generation Y nurses are quite comfortable in assuming because they often serve as mentors and resources to their own parents in the use of new technology. It can help foster stronger team relationships because it reinforces that different generations bring different strengths to the workplace and helps to build the confidence of Generation Y nurses. Generation Y nurses view themselves as leaders.28 With careful mentorship and nurturing, they will be excellent candidates to step into perioperative leadership roles in the future. CONCLUSION The attitudes, values, and beliefs of Generation Y nurses often challenge traditional perceptions of profession held by nursing leaders. Adaptive leaders will work hard to get beyond their experience bias to appreciate the strengths that this new generation of nurses can bring to perioperative nursing. By flexing their leadership style, nurse leaders will be the key to effectively recruiting and retaining Generation Y nurses. There is much to teach them, but it is also important to be open and curious about what drives their passion. Gloria Steinem once observed that across generations “there is as much to learn as there is to teach.”29 This is sage advice for all perioperative nurse leaders to take into the future.
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Rose O. Sherman, EdD, RN, NEA-BC, FAAN, is a professor of nursing and the director of the Nursing Leadership Institute, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL. Ms Sherman has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
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