From nurse education, clinical, or workforce issues through to healthy living, Nursing Review has it covered.

Most young nurses are passionate about their career choice ­ for now, at least. As many feel little long-term loyalty to a profession that leaves them feeling tired, stressed, and underappreciated, FIONA CASSIE talks to researcher Dr Isabel Jamieson about the workforce implications of her survey of more than 350 Generation Y nurses.

Lounging on the beach with your iPhone, thinking up creative solutions for the world’s problems, is the stereotype of the ideal Generation Y job.

Gen Y nurses can’t do that, and neither do they want to, found nurse researcher Isabel Jamieson. Instead, young Kiwi nurses want to be at the bedside making a difference by providing hands-on nursing care.

They share the traditional values of altruism that’s motivated generations of nurses – just, it appears, not the old-fashioned notion of vocation.

Although passionate about their career choice now, like many of their Gen Y peers, life-long loyalty to a profession is another matter.

Jamieson says this, and other findings about what motivates and concerns this newest generation of nurses, has major workforce implications if the profession, employers, and policy makers don’t work together to create a workplace and work conditions that keeps Gen Y nurses nursing.

With an average age of 25, and four years experience, or fewer under their belt, her respondents were young nurses happy to be nurses but not happy about excess stress levels, workplace bullying, salaries, the impact of shift work, and baby boomer nurses telling them they are not well prepared. And to cap it all off, nursing only ticks off some of the boxes of what Gen Y want from a long-term career.

Jamieson, a senior lecturer at Christchurch Polytechnic Institute of Technology, set out in her PhD research to find out the views of New Zealand Gen Y nurses towards nursing, work and career.

Her online survey was sent out in late 2009 to nearly 540 New Zealand registered nurses born between 1980–1988 and drew 358 responses – a two-thirds response rate and a sample equivalent to nearly ten per cent of the total cohort of Gen Y nurses.

Why nursing?

So what motivated these children of Baby Boomers – a techno-savvy generation negatively stereotyped by some as too casual and praise-seeking – to go into nursing?

Jamieson found the old-fashioned ideals of being able to help others, work closely with people, and contribute to society were major motivators for Gen Y nurses, along with nursing being seen as “interesting”, “challenging”, and “exciting” work.

Rated as less important but still important factors were the more extrinsic rewards of starting salary, flexibility of hours, chances for promotion, autonomy, job security, and being able to combine nursing work with family commitments. Family, friends, career advisors, or teachers had little part to play in their decision to go into nursing.

Once out in the workplace, the vast majority did not regret their career choice and many spoke of their passion for nursing.

“This cohort was overwhelmingly proud to be nurses, which is great to know they are really happy that they have chosen nursing,” says Jamieson. “Nursing would appear to be attracting young people who are entering nursing for all the right reasons … they are altruistic in nature, which is also supposed to be a characteristic of Gen Y.”

When asked about their five-year career plan, the majority were keen to remain at the bedside gaining clinical experience, with a number looking at postgraduate study and looking for promotion, including working their way through the professional development recognition programme (PDRP) process.

Surprisingly to Jamieson, only about 40 per cent of these young nurses were looking to work overseas, and even then, they weren’t racing to start their OE in a big hurry and most planned to return after one or two years away.

“I was wondering whether programmes like NETP (nursing entry to practice) was retaining them in New Zealand in those early years and also whether constraints like work visas and increasing barriers to working in Britain is encouraging them to stay.”

It is what happens after that five-year plan is fulfilled that Jamieson believes the profession and workplaces should be worried about. This is a cohort of proud nurses who view themselves as career-motivated but are less clear whether nursing will be their long-term career.

Forty-four per cent feel no pressures to keep them in nursing, only half think it would be too costly to change profession, only 22 per cent are in nursing because of a sense of loyalty to the profession, and only 20 per cent believe that people educated in a profession should commit to that profession for a “reasonable time”.

What ends the honeymoon with nursing?

“What happens with this cohort is that they are wildly enthusiastic when they first start,” says Jamieson.

“But within one year, the honeymoon is well and truly over and they are considering other options …”

So what dampens the enthusiasm? Jamieson found stress and tiredness was taking its toll on a generation who values work-life balance highly. “They wanted rosters and a workload that didn’t mean they had to spend their days off sleeping to recover,” says Jamieson.

She says the young nurses showed a very fair and mature attitude in recognising they needed to leave space in their days off to ensure they were fit and ready for work. But in return, they also wanted to be allowed time to enjoy friends and family and squeeze in study. They also felt their workplace wasn’t meeting that side of the bargain by providing a work life allowing them time and energy to do both.

Jamieson says Gen Y nurses are unwilling to quietly accept a workload they see as unreasonable and unsafe.

“They say we need to bargain around this – if you want me to be the best nurse I can be, then I need a workload that doesn’t stress me to the max,” says Jamieson. “Because they want to be very good nurses, they want to put into practice everything they have learnt.”

The realities of shiftwork are more of a challenge than expected and enough to turn some off the profession.

“I guess that suggests that more needs to be done in undergraduate programmes to better prepare those student nurses for the realities of shiftwork.”

Another solution, once they are in the workplace, is for young nurses to be given strategies on how to cope with shiftwork and ensure they understand their part in the ‘big picture’ of how their unit and hospital is run.

Young nurses are also seeing high levels of bullying amongst their nursing colleagues, with 37 per cent report having seen evidence of bullying on their ward.

“It’s a lot and it’s not good enough,” says Jamieson. “I don’t think it’s unique to nursing, but it needs to be addressed as the downstream effect is catastrophic.”

Generation gap tensions are also evident. As despite it now being nearly 40 years since nurse training first started moving away from hospitals and into the tertiary sector, there is still some tension between the hospital-trained baby boomers and tertiary-trained nurses.

Jamieson says one Gen Y respondent potentially summed up the tension well by saying, “there seems to be an inherent thinking that we’re incompetent as new graduates, yet we’ve been spending three years demonstrating that we’re competent.” It is also clear that the disrespect often goes both ways.

“Possibly, it’s a reflection of their age and stage. However, there seems to be an overwhelming feeling in young nurses that nurses in management (like clinical nurse managers) are seen to be there because they failed at the bedside.”

Most of the free comments were disparaging about senior management, and only about a third felt that management in general respected and appreciated nurses.

Jamieson sees some irony in these tensions, as it is the Baby Boomers who raised Gen Y, and now they are employing and working with them.

She says the literature talks of Gen Y being raised by attentive ‘helicopter’ parents who continuously gave praise and told them they’ve done well, and of a generation of children used to being given certificates for attendance and told participation, not scores on the sports field, is what matters.

The literature also says that Baby Boomers and Gen Y are the closest generations ever, and generally, Gen Y and their Boomer parents get on very well.

“So you would hope by default they would also get on with the older nurses really well, but they don’t. There is quite a tension.”

Would mentoring extend the honeymoon?

So what else can nursing and employers do to capitalise on that initial enthusiasm and counter the negative start many young nurses are reporting?

During her survey, Jamieson found an unhealthy ‘disconnect’ between what Gen Y nurses expect in a career and what they believe nursing delivers.

Her respondents strongly endorsed the nine career factors identified as being important to Gen Y workers, but nursing was seen to be failing to deliver these on a number of fronts.

While the vast majority saw their nursing career providing the factors of challenging work, access to ongoing education, and team work, there was a much more mixed response to whether nursing provided the creativity, regular feedback, and mentoring that they also valued highly.

Jamieson found it surprising that nursing was seen not to be creative, but says the key factor for Gen Y is wanting feedback and mentorship.

While two-thirds of respondents were satisfied with the way they were supervised, there were relatively low levels of satisfaction with the NETP (nursing entry to practice) programmes (54 per cent satisfied or fairly satisfied) set up to support new graduates in their first year of practice. Jamieson says NETP result should be taken with a high degree of caution, as it was just one question and few free comments were made about NETP, but respondents were clear on the desire for more feedback.

“They want feedback and they want regular feedback and are quite clear that they are not getting this.”

The introduction of some form of mentorship or clinical supervision (which is already part and parcel of mental health nurse practice) may be an answer to meeting this currently unmet Gen Y need.

“You don’t want to throw all the support into year one and then they are dropped in it … ongoing support is important.”

When it came to pay, they clearly wanted more. Particularly with the potential for young nurses reaching within five years the top of both the pay scale and PDRP, raising the question whether either or both should be extended. “They can plateau very quickly in their career.”

Pay was important, but it wasn’t the deal breaker that the work-life balance was, and Jamieson says it is imperative that managers address Gen Y concerns about working conditions if they want to keep them in the profession

Market nursing to nurses

Nursing also has to do better at marketing the plethora of career opportunities and the flexibility of the profession to its newest recruits, believes Jamieson.

In recent years, nursing has had no difficulty in attracting young people to study as nurses, but once they are at the bedside, Jamieson says more should be done to sell the profession to its newest generation. Steps that could be taken include the relative ease that nurses can move from one area of practice to another and the fluidity that allows nurses to move up and down the nursing hierarchy to meet their lifestyle needs.

Nursing should also tap into young nurses’ initial enthusiasm by offering and supporting formal career planning right from year one. By mapping out a clinical career path for new graduates early in their career, the notion of nursing as a “career for life” can be promoted.

The older generation of nurses also need to promote the career to those they want to step into their shoes. “But if they are feeling a bit burned out, frustrated, and overworked, they are not going to be sending good messages.”

With budgetary constraints, staffing numbers challenged, and high acuity patients, it is a challenge to the whole health system to ensure nursing can be viewed as an attractive career to this next generation, says Jamieson.

While Gen Y nurses are passionate now, how many of them that will still be around to mentor their children’s generation into the profession is the big unknown.

GENERATION GAP

Veterans born 1925–1945

Baby Boomers born 1946–1965

Generation X born 1966–1979

Generation born 1980–1994

Generation Z born 1995+

NB: generation definitions used in Jamieson’s PhD thesis

SUGGESTED CHARACTERISTICS OF GEN Y

• Work-life balance matters

• Favour flexibility in the workplace

• Workplace culture important

• Value mentorship

• Want regular feedback from managers

• Like change and variety

• Computer-savvy and fast learners

• Children of the Baby Boomers

SOME NZ GEN Y SURVEY FINDINGS

• 81 per cent were proud to be nurses.

• 73 per cent are enthusiastic about being a nurse.

• 73 per cent were satisfied with the care they are able to provide.

• 58 per cent were satisfied with their salary.

• 54 per cent were satisfied with NETP (new graduate programme).

• 47 per cent find nursing work stressful.

• 39 per cent find nursing work repetitive.

• 37 per cent note that bullying of co-workers occurs.

Career commitment of Gen Y nurses

• 64 per cent would continue to nurse even if they didn’t need the income.

• Only 3 per cent regretted becoming a nurse.

• 61 per cent consider themselves to be career motivated.

BUT

• 47 per cent do not feel obliged to stay nursing.

• 48 per cent would not feel guilty if they left the profession.

• 40 per cent were considering working overseas but planned to return.