Millennials, individuals born between 1981 and 1997, make up the largest generational cohort in the US workforce. It is important that employers understand what drives this segment of the workforce and how to retain them. This is especially important in hospitals where millennial nurses make up a large sector of the workforce. Research suggests that nurses who work in a professional practice environment experience more job satisfaction. The purpose of this study was to assess the extent to which the demographics of age, gender, race, ethnicity, work status, years of experience in nursing and years of experience in the current setting, the professional practice environment, and the 9 components of the professional practice work environment inventory explain work satisfaction in this sample of millennial nurses. Results of this study may help guide the development of strategies to enhance millennial nurse satisfaction in the workplace.
In the United States, millennials represent about 30% of the US workforce.1 In general, millennials are known for being technologically proficient and prefer to use technology to communicate.2 Millennials access information using the internet, mobile devices, and social media.3 They were raised in a diverse society, enjoy giving back to the community, and are hardworking and engaged if they believe in the values of their organization.
Millennials in the Workforce
Research suggests that compared with other cohorts, millennials value commitment, compensation, and communication differently than other generational counterparts.4 Millennials are educated; expect to work in a safe, flexible, motivating environment; and want to be recognized. Millennials dislike traditional hierarchy and instead prefer coaches to bosses.5 They want to work collaboratively and enjoy learning from others. Millennials value meaningful work, competence and self-efficacy, healthy interpersonal relationships and work environments, autonomy, career development, safety, coaching leadership, and financial motivators.2 Millennials want open communication, prefer a collaborative culture rather than a competitive one, thrive on improving the systems around them, and succeed in environments where learning and simulation are offered.6 Millennials want jobs with a purpose offering professional development that focus on their strengths, coaches rather than bosses, and ongoing conversations about their progress and to feel valued in their work.7
Millennial Nurses in the Workforce
Nursing has become a popular career choice for many millennials.8 According to data from the Bureau of Labor Statistics, individuals born in the late 1980s were 65% more likely to enter nursing compared with those born in 1955.8,9 It is predicted that the nursing workforce beyond 2020 will be dominated by millennials. Therefore, it is important for employers and managers to understand how to retain them.
Millennial Nurses Are Less Satisfied
Research suggests, however, that many millennials are not satisfied in their work. A Gallup survey7 indicated that millennials are the least engaged generation in the workforce at 55% compared with 48% of baby boomers and 41% of traditionalists. The 1st 3 years of employment for millennials working in healthcare is crucial.10 Millennial nurses are more likely to experience burnout, stress, high turnover rates, and lower rates of dedication to their workplace than their counterparts in other generational cohorts.4,7,11,12 Studies estimate the turnover rate for millennials to be as high as 57% after 2 years of employment.2,10,13,14 A recent Gallup poll survey found that as many as 60% of millennials were open to different job opportunities, which is 15 percentage points higher than nonmillennials.7
Direct care millennial nurses experience high levels of compassion fatigue.14,15 In a study of direct care nurses (N = 1400), millennials indicated high levels of compassion fatigue that contributed to turnover.15 Researchers discovered that millennial nurses were more likely to experience higher levels of burnout, secondary traumatic stress, and compassion fatigue than their counterparts in other generational cohorts. Compassion fatigue resulted in turnover, safety risks, and poor judgment.14,15
Dissatisfaction, burnout, and high turnover are significant problems for hospitals. These problems directly impact recruitment, retention, productivity, morale, quality, and safety.10 The average time it takes to recruit an experienced nurse is 82 days, regardless of specialty.10 The cost of turnover in lost productivity, overtime expenses, closed hospital beds, and use of temporary nursing staff negatively impacts the financial margin. Turnover costs include advertising costs, vacancy and hiring costs, and orientation and training costs.16 A national survey of 137 healthcare facilities across the country indicated that the average cost of turnover for a bedside nurse ranges from $38 000 to $61 100, resulting in the average hospital losing $4.4 million to $7 million annually.16
Patient quality of care is impacted by nursing dissatisfaction, burnout, and turnover. Creating a positive practice environment enhances quality patient outcomes and nursing retention.17 Patient satisfaction scores are higher on units with healthy work environments.18 Hospital readmission rates for Medicare patients, falls, and pressure ulcers are associated with nursing satisfaction and work environment.17 Positive patient quality outcomes and patient experience are correlated to nursing work satisfaction and work environment.18
Professional Practice Environment
Numerous studies support the premise that a professional practice environment consisting of autonomy, teamwork, and internal work motivation drives millennial nurse satisfaction.11,12,14,19 In addition, a recent systematic literature review concluded that a positive practice environment is essential to patient safety and nursing well-being.20 Healthy work environments are linked to patient satisfaction, nursing attraction and retention, job satisfaction, and lower risk of job stress and burnout.20
While research supports the benefits of a professional practice environment, less is known about the relationship between the professional practice environment and work satisfaction among millennial nurses. Therefore, the purpose of our study was to assess the extent to which the demographic characteristics (age, gender, race, work status, years of experience in nursing, and years of experience in the current setting) and the professional practice environment (including 9 subscales) explain work satisfaction among millennial nurses.
This study was guided by the Practice Environment Conceptual Framework developed by Erickson and colleagues.21,22 The framework contains 9 organizational characteristics that are believed to enhance nursing practice and improve nurse satisfaction including leadership and autonomy, nurse-physician relations, control over practice, communication, teamwork, conflict management, internal work motivation, and cultural sensitivity (Figure 1).
Study Design and Setting
This project was a secondary analysis of data collected in the spring of 2017 using the 2017 Staff Perceptions of the Professional Practice Environment. The data were collected in a large, Magnet®-recognized academic medical center in the northeast. The hospital institutional review board reviewed and approved the study as exempt.
The survey was distributed via work email to all inpatient and outpatient nurses (N = 3506). The email included instructions on how to complete the survey, approximate time it would take to complete, and a link to the survey. Nurses received weekly email reminders for 3 consecutive weeks. Completion of the survey implied consent. One thousand six (n = 1006) nurses participated in the survey for a response rate of 28.3%. One hundred eighty-one (n = 181) were excluded for missing data. Of the remaining 825 surveys, 375 (45%) were millennial nurses, those born between 1981 and 1997. Although all inpatient and outpatient nurses at the study institution were invited to participate in the survey, the respondents were not asked to identify their department, their work schedule, or primary shift.
Demographic data included age, gender, race, work status, highest degree in nursing, years of experience in nursing, and years of nursing in current setting.
Professional Practice Environment
The professional practice environment was measured using the Professional Practice Work Environment Inventory (PPWEI).21 The PPWEI consisted of 72 items rated on a 6-point Likert-type scale. The 6-point Likert-type scale ranged from strongly disagree (1) to strongly agree (6). The survey measured the 9 subscales of autonomy and control over practice, communication, cultural sensitivity, handling disagreement and conflict, nurse-physician relationships, staffing and resources, supportive leadership, teamwork, and work motivation. Research with this instrument in a similar population found an a of .93 with a range of .82 to .93 for the subscales.21 Work satisfaction was measured using 1 item, “Overall, how satisfied or dissatisfied are you working in your primary unit/department?” and was ranked on a 6-point Likert scale ranging from strongly disagree to strongly agree, with higher scores indicating greater work satisfaction.
Data were analyzed using SPSS version 22 (IBM Corp, Armonk, New York). Descriptive statistics were used to describe each variable. Multivariate regression analysis was used to identify relationship between age, gender, race, work status, years of experience in nursing, and years of experience in the current setting and the 9 subscales of the professional practice environment to work satisfaction.
The sample is described in Table 1. The average age was 29 years. The majority of millennial nurses were female (93% [n = 349]), worked on a full-time basis (88% [n = 328]), and had an average of 5.4 years of nursing experience primarily in the same institution (average, 5.2 years). The scores of the PPWEI subscales ranged from 4.0 to 5.3.
The scores for each subscale are depicted in Table 2. The majority (86% [n = 322]) of the respondents were somewhat satisfied, satisfied, or very satisfied working in their primary unit or department. Only 14% (n = 53) reported they were somewhat dissatisfied to very dissatisfied working in their primary unit or department.
The research question was answered using hierarchical multiple regression analysis. Two sets of predictors were entered in a stepwise fashion. The 1st set comprised the demographic variables of age, gender, race, work status, years in the profession, and years at the study institution. The 2nd set comprised the 9 professional practice environment subscale scores. In the 1st set, age accounted for 2.6% of the variance. The mean is highest for work motivation at 5.15% as noted in Table 2. Using analysis of variance (ANOVA), supportive leadership accounts for an additional 63% of variance (Table 3). Work motivation, resources for quality patient care, and teamwork explained the variance in the dependent variable. Older nurses in this millennial group who reported higher supportive leadership, work motivation, and more resources for quality patient care scores also reported higher work satisfaction scores than their counterparts. Survey questions on supportive leadership are found in Figure 2.
Our study is among the 1st to explore millennial nurse perception of the professional practice environment and the indicators that influence job satisfaction. While previous research suggests that millennial nurses suffer from dissatisfaction and burnout, the majority of millennial nurses in this study were satisfied with their work. Consistent with prior research, autonomy, teamwork, and work motivation contributed to millennial nurse work satisfaction.11,12,14,19 However, this study found that supportive leadership was the key driver to millennial nurse work satisfaction.
Using qualitative methods, Anselmo-Witzel and colleagues20 studied millennial nurses working in an urban, Magnet designated hospital. They found that millennial nurses were motivated by their experiences of autonomy. Overall, millennials felt good about being a patient advocate. Millennial nurses believed they made a difference in helping patients by achieving positive patient outcomes. Nurses reported feeling passionate about nursing.20 The nurses shared that experiences of teamwork and having friendships with coworkers were very important to their overall satisfaction. Our study using quantitative methods supports these findings, suggesting that millennial nurses who work in a professional practice environment that promotes autonomy, teamwork, and work motivation experience overall satisfaction in their workplace.
Likewise, our study supports the work of others who found several factors that influences millennials' work satisfaction. Saber15 conducted a literature review of predictors of satisfaction for seasoned and new-graduate RNs. Saber15 concluded that millennials rated group cohesion or teamwork as highest determinant to work satisfaction than any other cohort. The author suggested that improving teamwork strategies in the workplace could change the negative, unsupportive clinical environments of the past. Implementing unit-specific strategies to improve teamwork and collegiality among staff, organized mentorship and guidance to provide continued structured support, offering growth opportunities, and participation in unit activities contribute to millennial satisfaction with work.14 Chung and Fitzsimons2 identified several internal and external work motivators that drive satisfaction. Healthy interpersonal relationships, meaningful work, autonomy, and a workplace where growth opportunities exist are intrinsic motivators that contribute to millennial work satisfaction. Extrinsic motivators such as healthy work environment, safety, workplace stress, leadership, communication, and compensation contribute to workplace satisfaction. It is possible that supportive leaders create an atmosphere of teamwork and collegiality, and this suggests that additional research is needed to understand how millennials defined supportive leaders.
Our study was conducted at a large, Magnet designated academic medical center in the northeast using a convenience sample of nurses. The results may not be generalizable to non–Magnet designated, community, Veterans Administration hospitals, or rural hospital. The sample of nurses was somewhat homogenous in terms of race, gender, work status, and educational background. The impact of academic preparation was not assessed. While supportive leadership had a significant influence in millennial nurse satisfaction, this study did not analyze different leadership styles. Additional research is needed to understand what type of leadership millennial nurses perceive to be most supportive.
Implications for Nurse Executives
The average job tenure for individuals aged 25 to 34 years is 2.8 years.23 Understanding leadership characteristics needed to retain millennials is important. Supportive leadership plays a critical role in influencing work satisfaction among millennial nurses. Faller and Gogek24 report that effective leadership is an important way to engage millennial nurses. Effective leaders are those who earn the trust of millennials, who are good at their jobs, who care about the millennial as a person, and who support the millennials' career development.24 In a recent study by Burke and colleagues,23 nurse directors whose leadership characteristics empower staff, exhibit meaningful connections with staff, and are visible in the clinical area and role modeling professional behaviors contribute to nurse satisfaction. Although Burke and colleagues'23 study can be applied to all generational cohorts, the concepts of leadership caring behavior, empowering staff, and leadership presence are central to millennial nurse work satisfaction. A review of the healthcare organization's leadership development programs is critical to ensure nursing leaders provide the skills necessary to effectively support the millennial workforce.
Patient safety and quality outcomes are directly related to the professional practice environment and work satisfaction. Supportive leadership is the most significant indicator of the professional practice environment influencing work satisfaction in millennial nurses. Millennial nurses are a growing sector of the healthcare workforce. It is important to keep millennial nurses satisfied in their workplace. Our study adds to the growing body of knowledge about millennial nurses, perceptions of the professional practice environment, and work satisfaction. Hospitals that invest in the work environment of millennial nurses have the potential to improve RN retention rates, decrease RN turnover costs, and significantly improve patient outcomes.
The authors are grateful for the support of Mary Duffy, PhD, RN, FAAN, and Peggy Settle, PhD, RN, NE-BC, who were instrumental with analyzing the data for this project.
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