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Integrating Generational Perspectives in Nursing

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Marla J. Weston, MS, RN

ANA online CE credit-hours are available for this article.

Abstract

Although nurses from four different generations work closely together, tension may occur as the different generational perspectives result in misinterpretation and misunderstanding. Learning to create integrated and collegial relationships with people from different generations is a critical skill for nurses who work in multigenerational teams. This article will begin with a review of the historical perspective of the four generational cohorts currently in the workplace. This review will set a foundation for understanding each generation’s unique set of work and personal values. Then the article will discuss various sources of multigenerational misunderstandings and conclude with a discussion of approaches to strengthen intergenerational work teams. The article will emphasize that learning to appreciate the diverse points of view, leverage the strengths, and value the differences in colleagues from various generations can enable individuals to form creative, adaptable, and cohesive work groups.

Citation: Weston, M., (May 31, 2006) "Integrating Generational Perspectives in Nursing" OJIN: The Online Journal of Issues in Nursing Vol. 11 No. 2, Manuscript 1.

DOI: 10.3912/OJIN.Vol11No02Man01

Key words: age cohort, Baby Boomers, collaboration, collegiality, diversity, generation, Generation X, Millennial Generation, multigenerational, teamwork, Veteran Generation

The world around us has undergone dramatic transformations in the past 60 years. A few generations ago, businesses were largely the domain of white men with women and people of color playing supportive roles. Nurses were almost exclusively women working in hospitals, managed by male physicians and administrators. In the past few decades, a more diverse workforce has emerged both in business and in health care. Although we commonly think of enhancing diversity from a multi-racial or multi-ethnic perspective, diversification can also occur by having nurses and other health care workers from different generations work together. Just as individuals from diverse racial, ethnic, and gender backgrounds need to learn to respect and value differing perspectives and contributions, so do people from various generational cohorts. This article will begin with a review of the historical perspective of the four generational cohorts currently in the workplace. This review will set a foundation for understanding each generation’s unique set of work and personal values. Then the article will discuss various sources of multigenerational misunderstandings and conclude with a discussion of approaches to strengthen intergenerational work teams. In leveraging the power of generational diversity, it is important to understand the lived experiences and associated mental models of different generational cohorts. An underlying theme of this article is that learning to appreciate the diverse points of view, leverage the strengths, and value the differences in colleagues from various generations can enable individuals to form creative, adaptable, and cohesive work groups. The rich diversity of these generational perspectives, when valued, nurtured, and integrated, can lead to a more robust, creative, and adaptable work environment.

Four Generational Cohorts

The four generational cohorts discussed in this article include the Veteran Generation, the Baby Boomer Generation, Generation X, and the Millennial Generation. This section will describe and illustrate the historical, social, and cultural experiences of each generation which have formed the mental models so often seen in each of these generations.

Veteran Generation (Born between 1922 and 1945)

The childhood world of our most senior nurses, members of the Veteran Generation, was dramatically different than the one we live in today. News came largely from newspapers and radio; long-distance phone calls were a rare and expensive occurrence; shopping was mostly done at locally owned stores; and movies were only seen in the theater. As children, members of this generation were expected to be "seen and not heard." They were taught that their parents, teachers, and other authority figures were to be obeyed.


Over time, Veterans learned that they were rewarded if they obeyed the rules and worked hard.

Nurses of this generation were born during the Great Depression and World War II. As a result, their early childhood experiences occurred in times of great economic hardship. However, by the time this generation entered the workforce, the war and depression had ended and economic prosperity had become widespread. The middle class had emerged, and these families were able to thrive in a nice home on a single income. In contrast to the relative poverty of their youth, members of this generation today are financially stable (Zemke, Raines, & Filipczak, 2000). Accordingly, this generation has been instilled with the expectation that sacrifice and hard work are rewarded.

Although members of the Veteran Generation have adapted to a dramatically changing world around them, they have, like subsequent generations, continued to rely on early lessons in the workplace. Their early work environments were large, bureaucratic organizations with clearly delineated hierarchies. Rules, roles, policies, and procedures were plainly outlined. This standardization and structure contributed to the ability of organizations to grow, develop, and succeed. Achievement in this hierarchical structure was dependent upon employees who obeyed the rules and practiced within established parameters. Over time, Veterans learned that they were rewarded if they obeyed the rules and worked hard. Consequently, Veterans today value loyalty, respect authority, and expect rewards for hard work (Hatfield, 2002). As they near retirement, they fully anticipate reaping the rewards of their loyalty, longevity, and contributions in nursing.

Baby Boomer Generation (Born between 1945 and 1960)

Baby Boomers were born into the post-World War II economic prosperity and opportunity. The most noticeable difference between this generation and their predecessors was the introduction of television. In contrast to the Golden Age of Radio and the Silver Screen experienced by the Veteran Generation, Baby Boomers watched variety shows, movies, and sitcoms within their own home. News became more visual and dramatic as world-changing events, such as men landing on the moon and the shooting of a president, were seen on television.


The attention and prosperity afforded the Baby Boomer generation, along with changing world and societal values, created an emphasis on freedom to be yourself and the "me" generation.

From an early age, Boomers viewed the future with optimism and promise (Hicks & Hicks, 1999). As part of a large generational cohort and a member of smaller families, Boomers were doted on by parents, schools, and society as a whole. For the most part, they grew up in two-parent households where the father earned the family income and the mother was the home caretaker.

The attention and prosperity afforded the Baby Boomer generation, along with changing world and societal values, created an emphasis on freedom to be yourself and the "me" generation. Lack of conformity to the old rules became an established pattern. Everything from the justifiability of the Vietnam War to the limited role of women and people of color in society was debatable. Heroes were no longer men in positions of authority. Rather, those who questioned the status quo were the honored members of this generation. The experience of Watergate confirmed to Baby Boomers that people in positions of authority were not to be trusted. Long-standing societal rules and expectations were examined and altered, creating the assumption in the minds of Boomers that they should question authority and that the status quo could be transformed by working together (Lancaster & Stillman, 2002).

Currently, Baby Boomers represent about two-thirds of all U.S. workers (Zemke et al., 2000). They equate work with personal fulfillment and self-worth (Cordinez, 2002). They desire financial prosperity but long to make a significant contribution with their experience and expertise. They carry a deep-seated idealism and continue to be suspicious of people in positions of authority. As the generation that vowed to never trust anyone over 30 rapidly becomes the oldest generation in the workforce, they continue to be concerned with making a contribution, as well as ensuring their own youthfulness, wellness, and personal growth.

Generation X (Born between 1960 and 1980)

In contrast to the classic household experienced by Baby Boomers, many Generation X children lived in two-career households. Rising divorce rates resulted in 40% of Generation X children being raised in a single parent household (Strauss & Howe, 1991). In spite of this parenting change, the infrastructure for working mothers and single parents remained underdeveloped, resulting in a "latch key" generation. Many Generation Xers grew up as underprotected children in overly permissive homes in which parents frequently were absent (Kupperschmidt, 1998). Consequently, at a young age they learned to manage on their own, becoming adept, clever, and resourceful. Their friends became increasingly important, as well. Without the support of a large and extended family, teenage members of Generation X developed a reliance on a cadre of long-standing, close friends.


A lack of promotional opportunity and growth has contributed to the Generation Xers limited motivation to stay with the same employer.

In addition, for this generation, the role of children was changing. Rather than being "seen and not heard," Generation X members were often allowed to be equal participants in family discussions. Members of this generation learned at an early age to participate in conversations, advocate for their point of view, and expect to have their opinions considered.

Not only are the Generation Xers today assertive and self-directed, they are also comfortable with technology. Having grown up with microwaves, video games, and computers, they are adept at using technology and expect instant access to information. They are very media savvy, having matured surrounded by television and media messages. For this generation, the most haunting television image is that of the spaceship Challenger disaster, an event that most watched in the classroom. As people born after men landed on the moon, they intuitively understand that the world is one small ecology and one large, global economy.

Most significantly, members of Generation X understand employment in a very different way than their predecessors. Whereas their Veteran elders expected that career success involved long-standing loyalty to one organization, with a corresponding guaranteed employment for life, Generation Xers expect success from short term employment with less permanent relationships. As young children, Generation Xers watched their parents work extremely long hours and sacrifice leisure time for success at work. This alone has motivated them to desire employment where they can create a balance in their work and personal live. Reinforcing this perspective was the dramatic downsizing, reengineering, and layoffs experienced by their more senior colleagues, parents, and grandparents observed just as Generation Xers were entering the workforce. Generation Xers also faced limited growth prospects as members of previous generations were increasing salaries and fringe benefits by moving up the organizational ladder. Facilities had already begun flattening the hierarchical structure, eliminating promotional opportunities for young people. In addition, the large cohort of Baby Boomers remained in the workforce, filling those limited supervisory and managerial positions. A lack of promotional opportunity and growth has contributed to the Generation Xers limited motivation to stay with the same employer. This generation has taken the message of those transitions to heart, accepting that employment is not guaranteed. As a result, they do not see an advantage to being loyal or sacrificing for any one employer. Generation X nurses want to make money and have job satisfaction, but will not sacrifice their personal life for an employer who could let them go at any time. Further, they assume the responsibility to keep themselves employable by constantly updating their skills. They recognize that loyalty is a tentative pact, endurable only as long as both sides are obtaining value (Hicks & Hicks, 1999).


Generation X nurses want to make money and have job satisfaction, but will not sacrifice their personal life for an employer who could let them go at any time.

Due to the effects of these circumstances surrounding their early employment years, Generation Xers have often been maligned as disloyal and uncommitted. However, members of this generation are extremely loyal to their profession and career, but just not to the point of compromising their personal, professional, or family well being (Murray, 1997). As a result, rather than working for a single employer in a traditional relationship, members of this generation increasingly seek more temporary partnerships, such as "free agent" (Manion, 2002), float pool, registry, or travel nurse positions where they have more control over their schedules. Consistent with Generation Xers’ belief in their own responsibility for their employability and in the free agent work relationship, they have come to manage their own benefits, continuing education, and career path.

As businesses better understand Generation Xers, and as they mature, they are rapidly becoming a mainstay of organizations. Their resourcefulness, independence, strong peer friendships, technical sophistication, and adaptability to change are increasingly valued. More than that, Generation Xers have a pragmatic focus on outcomes, rather than process (Murray, 1997). As a result, they often can analyze bureaucratic barriers and identify innovative processes which produce better and more cost-effective outcomes.

Millennial Generation (Born between 1980 and 2000)

The Millennial Generation has nearly as many members as the Baby Boomer Generation. Once again with a large generational cohort, the spotlight has returned to children. During their youth, "baby on board" signs in automobiles signaled a resurgence of protectiveness and family values. Largely born to older mothers, their births were well attended by both parents with 70% of fathers watching their children’s delivery (Raines, 2003). Although 60% of Millennials were born into a home where both parents worked, in contrast to the experience of Generation Xers, an established infrastructure supported them and their parents. Childcare, preschool, and after school programs flourished. As a result, the lives of young Millennials were highly structured and scheduled with everything from soccer camp to piano lessons. In addition, with fewer children to attend to, their parents strove to be active and involved, mentoring, teaching, and serving as an ongoing advocate for the Millennial child’s well-being.


Today Millennials demonstrate a renewed sense of interest in contributing to the collective good and are volunteering for community service and joining organizations in record numbers.

Millennials have grown up in a multicultural, multiethnic, and global world with biracial and multicultural marriages forming families and neighborhoods with pluralistic backgrounds. This generation is the most traveled generation of all times and, with the Internet, are just as likely to have a pen pal on the other side of the world as the town next door. Communication through technology is a cornerstone for this generation with cell phones, text messaging, and email creating a constantly connected environment.

Yet the bombing of the federal building in Oklahoma City, the shootings at Columbine High School, and the terrorist attack of September 11, 2001, enveloped them in a world where a few individuals can cause devastating destruction and terror. A resurgence of heroism and patriotism has emerged out of these acts of violence. Today Millennials demonstrate a renewed sense of interest in contributing to the collective good and are volunteering for community service and joining organizations in record numbers. Described as sociable, confident, optimistic, talented, well-educated, collaborative, open-minded, and achievement-oriented, members of the Millennial Generation are being welcomed into the workplace as shortages exist in numerous settings (Raines, 2003).

Sources of Multigenerational Misunderstandings

Although largely over-generalized, the previous section captures the historical, social, and cultural differences of each generational cohort. Based upon world events that framed their youth and initial work experiences, members of each generation have develop somewhat unique mental models. These learned models/patterns are logical and consistent with their lived experience. Although each individual is unique, members of each generation do develop a collective personality with assumptions about organizations, attitudes related to authority, and expectations for success at work (Zemke et al. 2000).

Certainly, differences between generations are not new. However, two significant changes over the past 60 years have forced the current generations in the workforce into more intense interaction. First, the nature of work itself has shifted. In traditional, bureaucratic structures, the interactions between people from different generations followed hierarchical lines. People from younger generations were in entry-level positions and reported to people of the next generation in more senior positions, with the oldest generational members serving at the "top" of the organization. As a result, younger employees took direction from and followed the rules of people who were older. Although this structure is still common, the advent of total quality management and continuous quality improvement has led organizations to adopt a more team-based approach. In this arrangement, individuals from various "levels" of the organization are placed as equal members of a team, neutralizing the hierarchical structure and causing individuals of different age groups to interact as peers. Similarly, within nursing, shared leadership approaches and shared governance structures have facilitated decision making among nurses from various generations. Thus, the flattening of the hierarchy and involvement of employees in decision making has heightened the interaction of employees from different generations.


...older nurses are often dependent upon younger peers for coaching, mentoring, and guidance in using the computer...[t]he transition to the Information Age literally flipped generational relationships.

Secondly, the transformation from the industrial era to the Information Age also altered the interactions between people of differing generations. Historically, the most senior members of an organization offered the most reliable information and knowledge. Sixty years ago, young nurses encountering a patient with an unusual diagnosis relied on their more senior colleagues for instruction and advice. With the advent of the Information Age, young nurses today are not as reliant on their older peers. Rather, they can easily access expert information from around the world through their computer. The advent of computerization has not only broken the dependence of younger generations on more senior generations for information, it has also resulted in the unheard of precedence of having the youngest in the workforce be the most expert at a critical skill. Instead of young nurses turning to their older colleagues for advice, older nurses are often dependent upon their younger peers for coaching, mentoring, and guidance in using the computer for everything from documenting their work to accessing necessary information. The transition to the Information Age literally flipped generational relationships.

This transition has occurred in the context of the differing generational expectations and experiences described above. Yet members of each generation still operate as if their values and expectations are universal. Unquestioned assumptions often result in misinterpretation between generations. For example, Veteran nurses, who entered the workforce when success occurred through long-term employment with one organization, assume the same approach will ensure achievement today. They regularly construe their younger colleagues’ frequent job changes or working as an independent agent as an indication of lack of commitment or unreliability. In contrast, from a Generation X or Millennial nurse’s perspective, working hard for one employer offers very little long-term advantage in their career growth or financial viability. Younger nurses often assume that their older peers who have remained in one place of employment for their entire career have done so because of failure to take advantage of opportunities.

Strengthening Intergenerational Work Teams

Recognizing and appreciating different generational perspectives can both decrease tension and enhance personal and professional growth. For example, recognizing these different perspectives of both long-term and short-term employment, in light of each generation’s historical background, can help members of differing generations understand and appreciate the strategies others use when making career decisions. When older nurses can realize the inherent logic of their younger colleagues’ frequent job changes from the background of Xers’ and Millennials’ experiences, and younger nurses’ understand why their older colleagues have remained so long at one agency, they can respect each other more fully.

Likewise, recognizing other aspects of the mental models used by the different generations which often result in misunderstanding or frustration with their colleagues’ behaviors can assist members of different generations to work together. For example, having grown up in a world where their voice and contributions are expected, younger nurses are often misunderstood when they willingly advise their more senior colleagues who were taught to respect and listen to their elders. From a Veteran nurse’s perspective, the voiced criticisms of a novice nurse at a staff meeting may be seen as disrespectful, and thus discounted. From the novice’s perspective, speaking up even with limited experience is seen as contributing to the unit. When both generations understand each other, they can acknowledge and respond to this difference in expectations. In this regard, novices can be taught and advised that waiting for a few months after taking a new job before publicly sharing their perspective can often make their observations more acceptable to the group. Conversely, older nurses can invite and encourage their younger colleagues to share their initial observations, welcoming a fresh point of view.

Furthermore, learning from the unique strengths of each generation can both decrease tension and facilitate personal growth. For example, Baby Boomer nurses were among the first women and men who, in large numbers, were members of dual working couples needing to balance complicated work and personal lives. Younger nurses, having had the advantage of watching their own and their friends’ parents struggle through this challenge, have learned valuable lessons and often are much more adept at this skill. Unfortunately, rather than learning balance from Generation Xers, Boomers more typically malign their behavior as a sign of unreliability or lack of dedication. In the ideal situation, both generations learn from each other. Boomers can learn how to enact balance over the long-term, creating a healthier approach to life, reducing their stress, and enjoying both work and leisure time more. Generation Xers can learn that short-term sacrifice may be needed to leverage a long-term gain.


...learning from the unique strengths of each generation can both decrease tension and facilitate personal growth.

Working collegially with nurses from different generations offers the opportunity to explore new and different ways of thinking. Yet, all too frequently intergenerational interactions degenerate into conflicts due to a lack of appreciation, understanding, or just misinterpretation of other perspectives. Nurses who learn to acknowledge and appreciate their colleagues from different backgrounds have a distinct advantage as successful teamwork is increasingly required both for job satisfaction and the ability to positively impact patient outcomes. Teams are most successful when their members are not only individually competent but also cohesively united and energized.

Managing diversity has been described as "creating and maintaining an environment in which each person is respected because of his or her differences" (Davis, 2001, p. 161). This definition emphasizes that diversity is more than tolerating different point of views. Rather, diversity is valuing because of, not in spite of, differences. Recognizing and valuing the experiences and worldviews of members of different generations is instrumental in creating a cohesive workplace. Appreciating the diverse perspectives, acknowledging the various lived experiences, and creating an environment of respect is necessary for nurses of different generations to work together successfully. More than just learning to work well together, however, engaging people from different generations into a cohesive group can actually add value to nurses and to their practice. Diversity is a resource for creativity, learning, and efficiency (Stacey, 2003). If all nurses in the organization have the same generational mental model, little opportunity exists to explore different perspectives and learn from each other’s experiences. A well-integrated and diverse team offers a strategic advantage both in terms of the individual nurse and the team as a whole.


In the interaction of people from different generations in the workplace, members of the younger generation are always at a distinct disadvantage.

While learning can occur between nurses of all age groups, particular attention should be paid to engaging the perspective of younger nurses. In the interaction of people from different generations in the workplace, members of the younger generation are always at a distinct disadvantage. Not only is the existing organizational structure based upon successful strategies used in the past rather than designed for the future, but also older nurses are positioned to establish both the formal and informal rules. Because of their longevity in the organization, the older generations often dominate in managerial and leadership positions of power. As a result, older nurses typically are more influential when changes are made to modify the existing structure and processes. Naturally, these nurses update processes and rewards in a way that makes sense from their generational perspective, not recognizing that they are basing their decisions on historical assumptions that may not be held by younger nurses. Incorporating the perspective of younger generations forces an examination of generational assumptions and demands conscious identification of practices that make sense for all nurses.

Specifically integrating the values, assumptions, and perspectives of Generation X and the Millennial Generation into organizational practices can help move nursing operations more rapidly into the future. Integrating younger nurses’ values of participation, access to information, learning, and balance into nursing operations is important. Creating forums for nurses of all ages to provide input leverages the expertise of senior nurses and also provides an infrastructure for Generation X and Millennial Generation members to participate in the discussion and decision making. Shared governance or similar structures that enhance nurses’ control over their practice are ideal for this, particularly if nurses from multiple generations are included as members.

For these processes to work, older nurses need to learn to welcome input from their younger colleagues, even encouraging their younger peers to use their fresh viewpoints to identify where opportunities exist. Long-standing processes should be reevaluated in light of the Information Age, and young nurses can help identify where computerization can streamline or support nursing operations. Simultaneously, younger nurses need to be taught and learn to value the experience and expertise of more senior nurses who have a wealth of lived experiences to share.

Increasingly, organizations that support nursing processes like hiring, staffing, scheduling, and benefits management with the Internet have a strategic advantage in attracting and retaining younger nurses. In addition, supporting nurses who want flexibility and balance is the wave of the future. For example, accommodating a young nurse’s desire to play softball every week into the schedule may seem frivolous to older nurses who never prioritized exercise or friends into their busy lives. However, from a Generational X or Millennial nurse’s perspective, support of this small request confirms the organization’s commitment to balancing professional and personal life. Rather than viewing this as a burden to be accommodated, older nurses can learn from their younger colleagues how to balance work and play to support a holistically healthy approach to life.

Conclusion

The conscious examination of generational assumptions provides an opportunity to adopt the best that each generational perspective has to offer. Simultaneously, both cherishing the older wisdom and adapting newer perspectives can strengthen intergenerational teamwork and the nursing care provided (Spitzer, 2001). Cherishing the old does not necessarily mean an unwillingness to relinquish those aspects that no longer apply. Similarly, adapting to the new does not mean discounting tried and true ways. Valuing diverse generational points of view allows a respectful examination of alternatives. The strength of a cohesive team representing diverse generations of nurses allows for a balanced approach maximizing the positive contributions and minimizing the negative customs of each generation. The best teams can leverage the strength and contribution of each individual’s and each generational cohort’s skill set and strength. The hardworking, loyal Veteran; the idealist, passionate Baby Boomer; the technoliterate, adaptable Generation Xer; and the young, optimistic Millennial can coalesce into a powerful network of nurses with a remarkable ability to support each other and maximize their contribution to patient care.

Author

Marla J. Weston, MS, RN
E-mail: marlaweston@cox.net

Marla J. Weston is an experienced nurse, administrator, and health care consultant with over 20 years of experience. Her background includes developing professional nursing practice, mentoring nurses from different generations, developing leadership skills, and successfully implementing new programs. As a national expert on recruiting and retaining employees, she has studied and taught classes on the multigenerational workforce. Marla holds a Masters of Science in Nursing from Arizona State University and is currently enrolled in the University of Arizona College of Nursing doctoral program.

References

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Hicks, R., & Hicks, K. (1999). Boomers, Xers, and other strangers: Understanding the generational differences that divide us. Wheaton, IL, Tyndale.

Kupperschmidt, B. R. (1998). Understanding generation X employees. Journal of Nursing Administration, 28(12), 36-43.

Lancaster, L. C., & Stillman, D. (2002). When generations collide: Who they are, why they clash, how to solve the generational puzzle at work. New York: HarperCollins.

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Murray, N. D. (1997). Welcome to the future: The Millennial generation. NACE Journal, 57(3), 36-42.

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© 2006 OJIN: The Online Journal of Issues in Nursing
Article published May 31, 2006


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