Retention of well-prepared, qualified nurses is a high priority for healthcare organizations. Nurses constitute the largest group of healthcare workers, and fluctuations in the nursing workforce negatively influence patient care.1 Despite the growing nursing shortage and the dire need for a complete nursing workforce, retention rates among nurses continues to be a concern. Researchers project an increase in demand for RNs of roughly 1.5% per year from 2012 to 2025, which is slightly above the current projected growth of 1.3% per year during the same period.2 In addition to the continued need for more nurses, the reduced tenure of nurses has the potential to negatively impact the safety and quality of patient care. AMN Healthcare highlighted that the average tenure of workers ages 25-34 years is 2.8 years, which is significantly lower than the median tenure of 10.1 years for workers ages 55-64.3 Thus, the burden of the nursing shortage falls on a younger generation of the workforce: millennials.
The millennial generation includes individuals born between 1981 and 1996. This generation of nurses is rapidly growing and replacing the aging population of nurses.1,2 Despite a rapid increase in the availability of millennial nurses, evidence shows that nurses in this age group are more willing to leave their jobs.1 This article provides a critical evaluation of the perspectives of millennial nurses and necessary approaches to positively impact their job satisfaction and retention.
To provide support to millennial nurses, it's necessary to understand the perspectives of this generation and evaluate their motivation for choosing nursing as a profession. The literature consistently suggests that millennials choose nursing because of a desire to make an impact, answer a calling, and experience personal satisfaction in the nursing role.4 Millennials have a general propensity for meaningful work with opportunities to learn and grow.2 Few professions create the guaranteed opportunity for growth and career advancement like nursing. Therefore, it's not surprising that millennials are choosing nursing at such high rates.2
Millennials bring to the workforce a unique set of characteristics that, when properly developed, enable them to contribute to success in the workplace. This generation is drawn to organizations with a mission and a purpose that provide an opportunity to fulfill a personal calling.5 The focus of millennials is on making a difference and positively affecting patient and population health.4 Millennials bring a new dynamic to the work environment with an emphasis on expectations not present in previous generations. For example, research indicates these nurses aren't working for a paycheck but for a purpose.5 Millennial nurses place a high value on personal growth and development of strengths. As a result, these nurses view their job as not only a job but a part of life and the pursuit of advancement.5
Despite this seemingly optimistic set of values, challenges exist as high rates of attrition in this group reveal a disconnect between job satisfaction and role development. The millennial generation of nurses are significantly less satisfied with their employment than older generational cohorts.6 Millennial nurses have expectations of quality relationships and value a highly supportive environment.7 This is often interpreted as a need for constant positive feedback; however, the focus is more on regular interactions with constructive, developmental, nonjudgmental feedback. Additionally, this generation of nurses has low tolerance for incivility and will leave the workplace due to constant and unrecognized incivility.8 Although millennial nurses might be more demanding of workplace civility, ultimately, the work environment for all nurses should be one of mutual respect. Older coworkers should respect millennial nurses' knowledge and contributions, and the workplace should be an encouraging environment with supportive relationships. Successful implementation of this approach has the potential to positively impact retention of millennial nurses.
The literature suggests millennials are more likely to emphasize personal goals or advancement opportunities and will seek employment elsewhere if their expectations aren't met.1 Millennial nurses desire a work environment that encourages and fosters professional development. More than previous generations, millennial nurses have strong personal goals for higher education and advancement and value the pursuit of career goals over commitment to their current employer. An opportunity exists to work with this generation to address retention by creating prospects for growth and development within the organization.
Recommendations for leaders
In many aspects of nursing practice, we must shift our approach due to changing workforce demographics and an evolving workplace environment. The time has come to evaluate new and innovative ways to develop and retain millennial nurses. Three areas for consideration in changing the approach to practice are mentorship, support, and inclusion.
The current focus must be on how to develop and grow this generation into a necessary and valued workforce group. One important intervention for achieving this goal is providing mentorship. Millennials wish to be led rather than managed. Millennials don't want a boss; they want a coach.5 This generation cares about having a manager who can coach them and appreciate them both as individuals and employees with the ability to help them understand and build their strengths. The millennial generation values true mentorship in a safe environment from those who are older and more experienced. The mentorship approach shouldn't try to change an individual, but rather should focus on helping them to learn from the mentor's experiences and equipping them with skills for success. Sharing advice, personal experiences, and words of caution and asking questions that provoke thoughtfulness and contemplation create valuable teaching opportunities. Avoid approaching mentorship from a position of leading, controlling, or commanding. Millennials tend to view lecturing and commanding as offensive. This often results in distance between the mentor and mentee and unwillingness to seek counsel.9
The mentorship process should include the modeling of behaviors. Millennials are perceived to demonstrate negative characteristics such as entitlement, overconfidence, and self-importance.9 It may be argued that these characteristics often result from a lack of modeling and accountability for behaviors. Leaders should foster a mutually respectful relationship with clear expectations. Overall, these behaviors reflect a leader-coach or servant-leader approach that builds trust and promotes optimal behavior and learning.10
The millennial generation expresses a desire for a safety net of support in their roles.1 Millennials typically present themselves as confident and independent; however, there's often an unspoken need for intentional support from their direct leaders. Millennial workers are more engaged when their managers provide frequent and consistent communication and feedback.5 Furthermore, millennial RNs expect that they won't have to always seek out support and feedback. They'd like nurse leaders to be available and offer support willingly. Millennials want to feel like their leaders are allies who want them to succeed.
Mutual respect is highly valued by the millennial generation. Mutual respect is a two-way relationship between members of a group with the development of open and trusting communication.11 Nurse leaders should create an environment of mutual respect by being open and honest with a moderate level of transparency. It's important to recognize that the openness is two-sided, and nurse leaders should give value and opportunity to engaging in open and trusting communication with millennial nurses. Developing mutual respect starts with listening and asking questions without giving feedback.
Opportunities for professional development. According to the Gallup report How Millennials Want to Work and Live, most millennials indicate that opportunities to learn and grow are extremely important to them when applying for a job.5 It's one of the top factors in retaining millennials and the only aspect of retention that's unique to this generation.5 It's important to note that millennials won't wait to “earn” their right for development. This generation consistently feels empowered and doesn't believe opportunities for development should come only through tenure.
Nursing professional development is vital to the growth of the nursing workforce. Millennial nurses overwhelmingly indicate that the quality of patient care they deliver is positively influenced by professional development opportunities.3 Nurse leaders should provide opportunities for millennial nurses to participate in professional development early in their careers both within and outside of the organization. Encourage millennial nurses to take part in workshops, simulation events, blended learning activities, interprofessional development opportunities, and conferences. This involvement fosters the desire for growth and ongoing personal and professional development. Nurse leaders can critically evaluate the potential for growth in their nursing workforce and present available opportunities to millennial nurses. Providing financial support and incentives for participation can increase involvement in these activities.1 Creating opportunities that allow millennials to exercise what they learned through their professional development activities is also important.
Understanding and supporting career goals. Professional development not only includes development within the current nursing role but also advancement of education and career goals. Millennial nurses express a strong desire to continue with formal higher education and pursue career advancement.12 As a result, this generation of nurses is enrolling in higher education at a much earlier point in their career than previous generations. Millennial nurses are more likely to pursue advanced practice degrees and professional certifications. Four out of 10 millennial RNs are planning to obtain a master's degree, making this potentially the highest educated nursing workforce.3 According to the US Bureau of Labor Statistics, NPs are projected to have the fastest rate of employment growth of all nurse occupations at a rate of 28% during a 10-year period (2018-2028). This projection places NPs among the 10 fastest growing occupations in the economy.13 With an inclination toward professional growth through job change and educational achievement, it's not surprising that millennial RNs show a strong interest in advanced practice nursing with nearly half of millennial RNs planning to become advanced practice nurses.3 Millennials are also more likely to become leaders and express significantly more interest in leadership roles than previous generations.3 Pursuing and developing qualified millennial leaders can further develop and transform the healthcare landscape.
Research demonstrates that millennials expect an organization to provide new experiences or professional development activities and will make a change if these opportunities aren't available.1,14 Nurse leaders should take this into account when considering nurse retention. An organization that fails to support employees' personal education goals can result in premature loss of these individuals from their roles. Encouraging and facilitating the pursuit of higher education and advancement in their nursing careers can positively impact the potential for millennial nurses to stay committed to their organization and pursue advanced practice roles within the organization.
Career growth within the organization. One way to retain millennial nurses is by providing opportunities for career advancement within the organization. Commitment and loyalty to an organization is highly valued among this group when the opportunity exists for growth from within. High turnover rates among young, new nurses are very costly to healthcare organizations. The literature reports the cost to fill one nursing staff vacancy is between $40,000 and $60,000.1 The financial burden for organizations to fill these vacancies grows exponentially when considering the poor retention of new nurses.
A “grow your own” approach has the potential to increase commitment and reduce the cost of turnover. Approximately 24% of new graduate nurses will leave their first place of employment within the first year, and over 18% will leave within the first 2 years.15 With an understanding of younger nurses' desire to pursue career goals, organizations can design bridge programs to create opportunities for commitment to the organization. An example of a bridge program would be a medical-surgical bridge to specialty areas (such as critical care, emergency care, women's services, or pediatrics). Another approach is to create a “float pool” residency program where new graduate nurses are exposed to various practice environments and taught essential skills to safely care for patients in each area. At the end of the program, new graduate nurses are hired to a designated unit based on performance and interest.
Other bridge programs might focus on bridging from registered nursing to advanced nursing practice or bridging from clinical nursing to education or leadership roles. Bridge programs focused on advanced nursing roles will require organizations to invest in options for tuition reimbursement with a commitment to the organization following completion of the degree or certification. For nurses pursuing advanced practice roles, organizations should prioritize and commit to providing opportunities to complete required clinical experiences within the organization. For nurses pursuing education or leadership, create opportunities for shadowing and participation in appropriate organizational practices. Finally, a pledge to hire within or give priority consideration to internal candidates for advanced practice, educational, or leadership roles can increase commitment to an organization. Regardless of the strategy, a comprehensive, longitudinal workforce development approach is beneficial to retention within an organization rather than a specific role.
Millennials bring a new and refreshing perspective to the healthcare environment. There are currently four generations within the nursing workforce, and the input of all generations is needed to help with major decisions.16 Age-related stereotypes have been shown to negatively affect performance, and research indicates that millennials are most effective when paired with seasoned Generation X and baby boomer counterparts.17,18 Multigenerational teams can be very powerful when certain parameters are met, including challenging harmful stereotypes, encouraging open communication, respecting boundaries, and increasing inclusivity.19 Therefore, it's necessary to level the playing field and create opportunities for millennial nurses to equally contribute to decision-making. For powerful and successful innovation, leaders should invest in relationships that blend the best of what generational mixes offer.17 Millennials are uniquely qualified to engage in innovative disruption and developing approaches to solve the challenges faced in today's healthcare delivery. Allow this generation to have a voice by neutralizing hierarchy and status and creating an environment where everyone has equal footing.
Millennial nurses can have an unprecedented impact on the healthcare landscape. The focus should not be on changing the generation to fit the previous mold but rather on empowering and equipping them to greatly impact and continuously improve quality, patient-centered care. Mutual respect, encouragement, support, and personal and professional development may be the keys to retaining millennial nurses. A better understanding what motivates the millennial generation and the factors that provide them with professional satisfaction can aid leaders in attracting and retaining this important population of the nursing workforce.
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