Millennials will soon comprise 50% of the nursing workforce.1 Current leaders now look to this generation to assume leadership roles. This is challenging as nurse manager recruitment has become more difficult, and turnover has increased.2-3 Learning how to more effectively recruit, transition, and retain these emerging nurse leaders will be critical both to organizations and the future of nursing. Research with Millennials indicates that while they may seem confident about their abilities, there is a fear of failure when assuming new roles with complex responsibilities.4 Complicating the leadership transition process is a noted career trend that Millennials will quickly leave positions if they feel they are not receiving enough support and coaching.5
As Millennials explore leadership trajectory options, it is essential to recognize how their generational values and expectations of organizations shape their viewpoints to consider or reject leadership roles.6 The purpose of this article is to report on qualitative research that explored Millennial nurse managers' perspectives on their experiences in nurse leader roles in hospital settings. Their perceptions of role satisfaction, role expectations, organizational support and development, their leadership role impact, and barriers to success and intent to stay will be discussed.
Most staff nurses have little insight into the complexity of leadership roles and are often surprised at the challenges experienced by nurse managers when they assume the position.7 Historically, frontline nurse leaders have often “fallen into” their roles with little or no leadership development or mentoring.8 There has been more intentionality in the transition support of new graduates to their roles than given to the managers accountable to retain them.7 While guidance is provided by professional organizations about needed nurse manager competencies,9 robust orientation programs for managers are not in place in most environments despite the role being one of the most demanding in healthcare settings.10
The contemporary nurse manager role varies significantly across organizational settings concerning role responsibilities, the span of control, and administrative support. While the practice environment is known to influence a manager's satisfaction and retention in the role, too few organizations have been attentive to the complexity of the position as currently designed.11-12 Nurse manager stress, burnout, and resilience are growing concerns.13-14 The movement to a value-based care environment with an intense focus on performance as well as a growing nursing shortage has created pressing challenges for nurses in leadership roles.2 Nurse manager support has been found to be a key driver in novice nurse intent to stay.15-16
These challenges emphasize the immediate need to provide resources and support to the next generation of nurse leaders who are willing and able to assume these responsibilities.17-19 While research describing factors contributing to nursing leadership success exists,20-22 little is known about the factors that impact the decisions of Millennial nurses to accept and stay in nurse manager roles.4,23-24 With expanded roles in advanced practice now attracting Millennial nurses in large numbers,25 leadership roles must be equally appealing to be a viable career option. Mensik and Kennedy26 propose that future generational expectations about leadership roles will (and should) be different from their predecessors. It is vital for nurse leaders to understand what organizational factors are important to Millennial nurses so that meaningful changes can be made in leadership onboarding, director support, and the strategic design of the nurse manager role.27
Design and Sample
This was a qualitative interpretative study that explored the experience of being a Millennial nurse manager in the hospital setting. Institutional review board approval for the study was obtained from Florida Atlantic University prior to the recruitment of study participants. A national sample of RNs born between 1980 and 2000 with a minimum of 1 year of experience in the nurse manager role was recruited via the American Organization of Nurse Executives electronic newsletter with permission. Convenience and snowball sampling were also utilized. Participants represented 13 states and ranged in age from 28 to 36 years (mean, 32.4 years), of which 18 (72%) were in their 1st nurse manager position. On average, they managed 76 full-time equivalents (FTEs), whereas 9 (36%) reported managing more than 1 unit. Participation in a leadership development program was reported by 15 participants (60%). Participant demographics are reported in Table 1.
The study was conducted from March to May 2017. Participants verbally consented to participation and completed a demographic survey via email prior to the interviews. Audio-recorded telephone interviews were conducted and transcribed verbatim. The researcher-developed questions that guided the interviews are reported in Table 2. Interviews ranged from 22 to 62 minutes (mean, 38 minutes). Transcriptions and audio recordings were reviewed and then sent electronically to participants to validate the accuracy of the conversation.
The interview data were analyzed using the 7-step Colaizzi descriptive phenomenological method. Significant statements are identified, and meanings relevant to the phenomenon are then coded and clustered into subthemes and themes (Table 3). Computer-assisted software was utilized to organize coding and theme generation and enabled study auditability by the coresearchers. Trustworthiness was established through member checking, coding by 2 researchers, reflexivity, and an audit trail.
Themes of Experience, Influence, and Perception
Theme 1: Coming Into the Role
Millennial managers revealed direct supervisors played a pivotal role in the identification of their leadership potential prior to accepting the nurse manager position and described being groomed for the role by taking charge of their units. One manager reported, “I was fortunate enough to be brought into situations like evaluations… investigating incidents and preparing reports.” Notwithstanding, role acceptance was described as a challenge citing that it was often older nurses who presented the most resistance to having a Millennial in the manager role. One manager reported, “I'm the youngest nursing manager in this hospital… it was very difficult for me, and it still is to kind of integrate with the leadership team because they are so much older than I am… we don't think the same way.” Another reflected, “Some people look at you [when you're younger] like you can't do the job.” The challenge of transitioning into the role while learning the ropes was often unavoidable. One Millennial reported, “A lot of people looked at me as if I was a new graduate nurse. I had a lot to prove for them to accept me.”
Theme 2: Learning as I Go
There was wide variation in orientation to the role provided to these new managers. Some were provided formal orientation and mentors, but others were not. One Millennial maintained, “It was all informal; the education just happened as things came up.” Another reflected, “It would have been helpful to know what goes into your productive/nonproductive time… how overtime is calculated… how your hours-per patient-day statistic plays into that.” For many, understanding budgeting and finance was a key challenge when they initially began in the role. One young leader described these missing pieces as “…where I struggled the most… [If I understood] ‘why’ they might have to tell me no… because of the budget—I may have been able to understand a little bit better.” Another shared, “…I am this nurse, who is a Millennial, and I don't even know how to balance my checkbook… and now I'm in charge of a $1.2-million budget. It doesn't seem like a very good plan to me.” One manager noted, “I didn't expect that you'd kind of be thrown in the way I was—I just kind of learned on the go.” The perception that ‘luck’ in finding a good mentor or having a supportive director provided context for the subtheme feeling lucky. This perception was in response to a viewpoint that not all managers even within the same organization might have the same onboarding experience because there was not an intentional plan. One Millennial leader revealed, “If I had not had that period of acclimation, I would not have stuck around—but that happened completely by chance.”
Theme 3: Having the Support of My Director
Director support is key to Millennial satisfaction in the manager position. They define this as having directors who are “receptive to their needs” and responsive to their questions in a timely manner. One manager reported, when her inquiries were responded to “…either that day or the next day,” she felt that she was being heard and by extension being valued by her directors. Others reflected on the significance of support in terms of how supervisors and colleagues responded to their bringing innovative ideas to the proverbial table. The broad influence of director support found in the subtheme more than a feeling was expressed by the reflection “without the support of your director, a new nurse manager can feel like ‘eating your young’ is a true statement (for management as well as for the bedside nurse).”6 As these young managers reflected on retention and satisfaction variables, director support was often the common denominator. Feedback from their directors is perceived by these managers to be a significant expression of support. One manager reflected, “I think my generation likes to get feedback… I've actually learned that I have to ask my director for feedback.” The declaration, “I applied for this role, basically to go where she was” suggests it is important to consider the far-reaching implications of director support to nurse manager recruitment and retention.
Theme 4: Making an Impact
Millennial managers openly discussed the dual nature of their role in terms of impact. They recognized that a key aspect of their responsibility is the retention and satisfaction of their staff. At the same time, they are held accountable for unit-based performance metrics. The managers commented, “If my staff is happy, I'm happy” and “If your staff is satisfied, your patients will be satisfied.” They view staff satisfaction as key not only to retention but also to patient satisfaction. The capacity for this generation of nurse leaders to view retention in broad terms suggests they envision a markedly different interpretation of loyalty. The reflection “nursing has changed… nurses want to try new things… if we could keep them in our system, that would be a success to me” infers that these young leaders view retention and loyalty in terms of the organization as opposed to “the unit.” Without exception, relational and organizational metrics framed their perception of impact in the role. These young leaders acknowledged “Our organization measures… things you did not even know could be measured, and they have dashboards for every single thing. They measure success based on dashboards.” Nevertheless, the challenge to align relational goals remains, and the pressure to meet and exceed organizational success metrics provides support for the hard and soft skill requisites essential to role success.
Theme 5: Helping Staff Succeed
Millennial managers described their capacity to influence staff development as an indication of their professional success. A key satisfier for these leaders is the opportunity to create positive relational capital with staff by serving as a resource and as a motivator and was detailed in the subtheme developing others. One Millennial asserted, “I was able to get some of them to go to the preceptor class and become preceptors. I was able to get some to… become charge nurses. I don't think some of these nurses saw that in themselves.” These young leaders communicated an awareness of their responsibility to “set the tone” of the unit in terms of helping staff succeed. Equally important was their capacity to influence certification rates, which they described as both a personal and professional success metric.
Theme 6: Managing Change
Role complexity notwithstanding, Millennial managers were acutely aware that unexpected additions to their role responsibilities created significant challenges in managing change. The expectation that these young managers were responsible to “cover” staff, educator, and leadership vacancies was a common reflection. A manager who was covering 2 additional units for another manager confessed, “They need to get someone soon. I'm losing it… this is too much. I need people. I need educators. I need a manager… this is not doable.” Another echoed, “I'm exhausted because I don't have the resources that I need….” One Millennial nurse manager confided, “Sometimes I feel set up to fail because there are so many things to do… to determine what's the most important, what needs to get done right away.” The description of organizational priorities as a “moving target” of goals and initiatives was common among Millennial managers and provided an important frame of reference for the subtheme shifting priorities.
Theme 7: Trying to Stay Balanced
The collective view of these managers was that the role required a “24/7” commitment. Managers described their availability to the unit(s) as “around the clock” and “connected at all times.” One recounted, “So when I'm not here… they always call me. All the decisions are mine [even] when I'm not here.” As a result, the perception that staff presume managers are always accessible to them concerned even the most capable leader's quest to balance role demands. Balance for these young managers included meaningful face time with their staff. However, the sentiment “I feel like there are times where I have so many administrative things going on, that my staff don't even see me” suggests this is not always the case. Despite their awareness of role requisites, span of control and direct reports permeated their reflections on achieving balance.
Twenty-five participants, of which 92% worked in a not-for-profit hospital, may not fully capture the experience of Millennial nurse managers and is acknowledged as a potential study limitation. Additionally, the targeted nature of recruitment through professional organization membership and the cross-sectional design could be perceived as a limitation.
Leadership Interest in a Complex Role
Despite their role responsibilities and challenges, the managers interviewed in this study were committed to and interested in leadership roles. When asked what advice they would give to nurses contemplating the role, they recommended that prospective leaders clarify expectations and support variables prior to accepting the position. These managers acknowledged that the role is complex and complicated by competing priorities. Study findings suggest these conditions drew attention to gaps in role preparation and the notable variances in training among their colleagues. This insight coupled with insufficient human resource support to meet the needs of units under their span of control further challenged their ability to master role effectiveness.
Development, Retention, and Succession Planning
Millennial nurse managers are looking to current nurse leaders to guide, mentor, and assist them to navigate their role and fill in the gaps. This research suggests that organizations without formal leadership development processes run the risk of sending mixed messages of support to these young managers. The link between director support and professional development provides guidance regarding the need to both provide more effective onboarding of new leaders and to develop coaching skills of leaders in director roles. As a cohort, they reflected on role success in terms of their personal and professional impact on the capacity to engage their staff. These metrics provide insight into retention antecedents for this generation of nurse leaders. The findings from this research suggest a link between workload and role retention. For example, of the 36% of nurse managers in this study who managed more than 1 unit, 44% of them reported they either are planning to leave or were not certain if they would stay in the role. This research reaffirms the need to address leadership succession as an ongoing practice of academic and professional development rather than a reactionary one. In this study, many of the participants held “premanager” roles prior to the nurse manager position. Nevertheless, the absence of a formal trajectory for the role continues to create missed opportunities to cultivate the pipeline of Millennial nurse managers.
Meeting the pressing need for capable nurse leaders will require developing Millennials who can successfully navigate the nurse manager role. Findings from this study suggest that role support and professional development are essential to the Millennial nurse manager's perception of role success and satisfaction. This provides context for the study findings suggesting that there are many opportunities to standardize the onboarding and development practices of Millennial nurse managers. This research suggests innovative approaches to role design modification may be needed in order to frame the nurse manager position as desirable to the prospective Millennial nurse leader.
This research contributes to the body of knowledge on leadership and succession planning by presenting generationally sensitive findings related to role satisfaction, support, expectations, and intent to stay among Millennial nurse managers. To effectively recruit Millennial nurses into leadership roles, current leaders must consider organizational factors important to this generation. As the current healthcare landscape shows no signs of slowing down the need for competent nurse leaders, so must our efforts continue to identify and meet their needs.
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