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What CNOs Should Know About Millennial and Gen Z Nurses

Analysis  |  By Jennifer Thew RN  
   February 07, 2020

Millennial and Gen Z nurses cite team dynamics, professional growth opportunities, and flexible scheduling as important factors in the work environment as part of a new study.

"What matters to you?" This is a question the Institute for Healthcare Improvement encourages clinicians to ask patients to help create customized plans of care. Healthcare leaders can also ask this question of their staff members to improve the work environment and cultivate joy at work.

In this same vein, leaders at Nashville-based HCA Healthcare, with 94,000+ registered nurses, were curious about what matters to millennial and Gen Z nurses as those two groups have started to make up a larger portion of the nursing workforce.

"We've seen a big shift in our demographics now for about the last four years. We went from the millennials and the Gen Z being the minority in our employee population, particularly our nursing group, to now they're the majority," says Jane Englebright, PhD, RN CENP, FAAN, senior vice president and chief nurse executive at HCA Healthcare. "It was a pretty rapid swing for us, so we wanted to make sure we weren't missing anything and that we were meeting the needs of this changing workforce."

Hence, HCA Healthcare, teamed up with The Center for Generational Kinetics to study what drives, engages, and motivates millennial and Gen Z nurses. The results are published in the report, Employment Vitals: Millennial and Gen Z Nurse Expectations.

Here are some of the study's findings, which surveyed approximately 1,250 millennial and Gen Z nurses nationwide:

  • 44% of millennial and Gen Z nurses rate team and managerial relationships as the No. 1 dynamic in a positive work environment.
  • 42% say communication and the ability to make clinical decisions are important factors impacting the working environment. 43% of respondents indicate professional growth opportunities through career advancement are crucial.
  • More than one-third of the nurses surveyed say career advancement training, learning a new specialty, or getting a new certification, is the most helpful type of education they could receive at work.
  • More than 28% of millennial and Gen Z nurses cite the importance of modern facilities and updated equipment as contributing factors in creating a positive working environment.
  • Offering flexible work schedules was selected by 49% of respondents as a top organizational strategy that would absolutely make them feel supported by their employer.
  • When nurses were asked to choose the support system that means the most to them, 57% said they feel most supported through their team.
  • When it comes to career development, 28% of nurses rate moving to a different floor or department as equal to being given increasing amounts of responsibility.
  • One-third of nurses who have been in the field five years say moving to a different floor or department is one of their top two definitions of career progress. 39% of nurses with a six-year tenure said the same thing.
  • 64% of nurses who have been in nursing for nine years have been with their current employer four to five years.
  • Four to five years is how long most nurses with seven or more years of experience have been with their current employer, indicating earlier movement between employers.

In a recent interview with HealthLeaders, Englebright discusses the study's results and what nurse leaders should be aware of regarding the needs of millennial and Gen Z nurses. The transcript has been edited for clarity and brevity.  

HealthLeaders: To what do you attribute this change in demographics? Is it due to retirement of baby boomer nurses?

Jane Englebright: We definitely see retirement but, I think for us, a lot of it has been hiring more nurses, between the growth that we've had in HCA and the fact that so many nurses now aren't really choosing the hospital as their preferred place to work. There are so many more options out there for nurses, so we have been hiring new graduate nurses at a much higher rate than we have in the past. We've put a lot of support programs in like residency programs and things like that to support the new nurses. It's been a pretty marked change in terms of how many new people we're bringing into the profession every year.

HL: So, tell me what were the study findings?

Englebright: A lot of things we thought we knew, we validated, and then there were some other new insights that we didn't expect. We found out [nurses] have high expectations for their own performance, and they have really high expectations from us as an employer. We were pleased to see they were focused on teamwork and that their team was as important to them as their manager. They were really focused on their own personal development.

HL: It sounds like they view personal and professional development differently than previous generations of nursing. Can you explain that?

Englebright: They want to grow and develop and learn new things, but they want to do that at a little bit faster pace than what we have seen in the past. [M]ovement [in the organization] and doing something new and different feels like progression to them, whereas traditionally we thought if you weren't getting a promotion or moving into management, it wasn't progression. They see any opportunity to learn and gain new skills and knowledge as progression, which was refreshing to see.

HL: That's interesting. So, instead of a new title, you could give them a project to do?

Englebright: Changing specialties, changing settings, moving from an inpatient setting to an outpatient setting—all of those types of movements are exciting and motivating because they're learning new things.

HL: Are you seeing a lot of new grads who are interested in becoming nurse practitioners?

Englebright: We are seeing a lot of interest in the nurse practitioner role. We have a lot of those roles inside our hospitals and our other sites of care. I did a little bit of teaching here at Belmont [University] a couple of years ago, and I had people in my program fresh out of their undergraduate program. They were just going straight through. But we're trying to embrace that and begin to look at our medical-surgical units as places where they set the culture and they set expectations and get everybody started on the right foot.

HL: And it looks like the study also found that support and professional relationships are important to this group.

Englebright: They had a broad way in which they defined support and the type of support that they're looking for. They see that as some of the traditional things that we've done in terms of benefits, but they also see support as flexibility and scheduling.

Personal relationships are very important and feeling like a part of a team is important, and the amount of training that they have. Training has been a huge focus of ours, and we've doubled our efforts in that area. They also want the ability to have a voice, so we are seeing greater participation and involvement in our professional practice councils with this younger generation.

HL: What do you plan to do with the findings you have gained from the study?

Englebright: [We plan to share] them with our leaders so they can understand this group more. We're certainly looking at a lot of things that we've been doing. For example, I mentioned clinical education and how we had started the residency programs, but we're trying to take that to the next level by putting what we're calling "clinical advancement centers" in each one of our markets so that we can provide that education, growth, and retraining opportunities throughout the [nurse's] life cycle.

We just invested in a partnership with a nursing school, and we're hoping that that further strengthens our ability to provide learning opportunities throughout the career path of a nurse. And we're exploring how we can make it easier for nurses to move around inside HCA Healthcare. They know what's available in their hospital, but they may not know what's available in the other 180 hospitals in the system. That could offer them geographic mobility and new specialty or whatever it is they're looking for in terms of the next challenge in their career.

Editor's note: This article has been updated to reflect that the study was a nationwide survery.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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