Generational Differences in Nursing: Has the Work Ethic Changed?

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By Megan Murdock Krischke, contributor

May 6, 2014 - Can’t all the generations of nurses just get along--and work effectively together?

For the first time in history there are four distinct generations in the workplace--the Traditionalists (born before 1945), baby boomers (born 1945-1964), Generation X (born 1964-1980), and Generation Y, or Millennials (born 1980-2000).¹ This diversity can add to the challenges as well as to the benefits of working as a team in a health care setting.

Joan Kavanagh: Generational differences in nursing are less than many realize.
Joan M. Kavanagh, MSN, RN, NEA-BC, associate CNO at the Cleveland Clinic, asserts that nurses from different generations have more in common than they often realize.

“When it comes to work ethic across the generations, there are a lot of conflicting findings and perceptions,” stated Joan M. Kavanagh, MSN, RN, NEA-BC, associate chief nursing officer for nursing education and professional development at Cleveland Clinic (the Clinic). “Looking at fact versus fiction, it’s worth noting that there is more heterogeneity within generational groups than between generational groups.  We can’t assume that there is an innate generational tension or that costly turnover is directly attributable to work ethic. “

“Often Millennials get a bad rap,” Kavanaugh continued. “They may tend to change jobs more frequently, but much of that has to do with growth and expansion; their work ethic is intense and committed.   They tend to be innovators, entrepreneurs and bold risk takers. While those aren’t competencies we may have been looking for in the past, they are certainly competencies that will serve us well in this time of unprecedented change.”

Bonnie Clipper: The main generation gap is in communication.
Bonnie Clipper, DNP, says most of the generational tensions she encounters at work stem from communication differences.

“Most of the generational tensions I observe have to do with communication,” noted Bonnie Clipper, DNP, RN, MA, MBA, CENP, FACHE, vice president and chief nursing officer at Medical Center of the Rockies in Loveland, Colo.

“There are differing levels of formality, with the older generations preferring the use of titles and Mr. and Mrs., while the younger generations default to using first names, not only with peers, but with patients and supervisors.”

Kavanagh mentioned that a white paper from UNC Chapel Hill, entitled “Rethinking Generation Gaps in the Workplace: Focus on Shared Values,” has shaped some of her thinking on this subject. The paper points to research that show that Boomers, Gen Xers and Millenials all want the same things from their employers:

1. To work on challenging projects
2. Competitive compensation
3. Opportunities for advancement, and chances to learn and grow in their jobs
4. To be fairly treated
5. Work–life balance

“I feel in many ways that the generation gap is a myth--we have more in common than not,” asserted Kavanagh who participates in welcoming and orienting 1,000 new nurses to the Clinic annually.

And while all the generations value work–life balance, that can mean different things to the different generations.

“I see the older two generations working whenever they are asked, taking extra shifts, working extra hours,” remarked Clipper. “The younger two generations have more of a mindset that when their work is done, it is done.  They’ve done their time and if there is still a need it isn’t their responsibility.”

“Millennials can be very good employees and are more effective when they understand why they are being asked to do things,” she explained. “Rather than giving a Millennial a script about what to say to a patient, it is better to ask them, ‘What do you think would be the best way to communicate this to a patient?’ and involve them in the process.”

“Gen Xers and Millennials are great at multi-tasking and working with technology,” remarked Kavanagh. “I heard recently that 90 percent of the data that exists today did not exist two years ago.  This shows that young nurses are coming up in an age of data explosion, technological advancements and advancements in patient care.  The skill sets they bring to the job match this.  They have grown up in the information age and we should be celebrating that rather than looking at the challenges.”

“The older generations certainly bring valuable skills to the workplace, as well.  They know more about patience, they have had more opportunities to develop patience--it isn’t something you can just learn,” added Clipper.  “Younger generations are used to decisions being made in seconds, and the older generations could benefit from a sense of expedited decision making.”

“One thing to keep in mind,” she continued, “is that Millennials have been reared in packs.  In school they were put in groups and cohorts, and now they don’t want to make decisions on their own. All their training has been based on how to get along well with others. This often leads them to spend time talking with co-workers during down times, rather than seeking out additional tasks that need to be completed.”

“Nurse managers may need to put some effort into redirecting them and encouraging them to take time at the end of a shift, rather than during it, to catch up with coworkers,” Clipper added. “Xers, on the other hand, are much more likely to take initiative in pursuing additional tasks--they are much better at working independently.”

For nurse managers trying to build a successful intergenerational team, Kavanagh recommends fostering an appreciation of differences, while focusing on what the team has in common--such as common goals.

“Patient care is so complex today and everyone knows they can’t do it alone,” she noted. “This need can help a team to appreciate the diversity that each member brings.”


¹White, M. (2011). Rethinking Generation Gaps in the Workplace: Focus on Shared Values, UNC Executive Development. 

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