Today there are four generations of Nurses working in healthcare. In order to achieve a healthy work environment all generations must be culturally sensitive not only towards ethnicity but age as well. Below are a few tips to help managers and staff transition people into leadership roles. 

Christina is a 29-year-old RN, BSN and she recently obtained her MSN in clinical management. She has worked 3 years as a staff Nurse and wants to move into a leadership position. Some managers, and even some of her colleagues, feel that because of her age, Christina isn’t ready for leadership roles. 

This scenario describes many millennial nurses in practice settings today—eager to move up the career ladder and pursuing the advanced education that’s needed to do so. But like Christina, they may encounter resistance on their way up.

Better understanding the characteristics of the millennial generation can help managers foster healthier work environments and identify potential candidates for leadership positions. And millennial nurses who understand their own generation’s characteristics can more easily transition into leadership roles.

Who are the millennials?

A generation is usually defined roughly by a 20-year birth period. Currently four generations work side by side in nursing: silent generation (born 1928-1945), baby boomers (born 1946-1964), generation X (born 1965-1980), and millennials (born 1981-1997). =

In 2016, millennials surpassed baby boomers as the largest generation. Other names for this generation include generation Y (or Why), echo boomers, boomlets, linked generation, generation next, and nexters. Millennials will have a significant impact on the work environment and have largely influenced the development of social media. Companies such as Facebook, Instagram and Snapchat are led by millennial aged CEOs.

A generation experiences similar life and public events, and tend to have similar characteristics, values, beliefs, and behaviors. A significant event that influenced the millennials is the terrorist attack of 9/11. After this tragedy, millennials realized tomorrow is not a promise; they grew up with terrorism threats and war on the news daily. These public events have influenced them to live life to the fullest and pursue careers that make them happy.

Millennials are eager to impart their ideas, are technologically savvy, and can be quick to leave an organization that does not fit their needs. Millennial nurses don’t want to spend 15 years on a unit before any prospects of advancement become available. They saw their parents’ generation dedicate a majority of their career to one organization only to later be downsized and laid off. Today’s millennial nurse is more transient and seeks positions that offer work life balance and flexibility in schedules.

In the sandbox

Generations working well together promote workplace satisfaction, which ultimately improves patient outcomes. This sounds like the age old “everyone play nice in the sandbox,” but it contains like most adages, a nugget of truth. To facilitate collaboration and a healthy work environment, nurses of all generations must understand the diversity in today’s workplaces; not just in culture and ethnicity but age as well. Generational differences do not have to result in negativity; positive intergenerational relationships can be formed that benefit all involved.

Here are some tips for successful intergeneration cooperation that managers and staff alike can apply.

Value differences. Rather than point out negative characteristics of one another, use these varied personalities to value differences. What can an older nurse teach a younger nurse? Possible answers include dedication, patience, and shared life experiences that only come with time. Conversely, younger nurses may help older nurses see the value in varied job roles, the importance of valuing time off, and interest for advanced education.

Use generational relationships to your advantage. Find a mentor. If you are a millennial and desire upward career movement, find a leader who inspires you and can help you obtain the position you desire. For older generations, think about succession planning. Positively mentoring younger nurses can prove successful; by helping them understand the process of leadership roles you pass on your legacy.

Try reverse mentoring. Tech savvy nurses can help lesser skilled nurses become more proficient with the computers and technology that are a necessity in practice settings.

Listen to one another. Value input from all staff of all ages. Respect one another’s ideas, understanding that nurses on the front lines of care may have the best solutions. Nurses of all generations can contribute suggestions for improvement and practice environment enhancement.

Christina was paired with a nurse who is older and more experienced than her. She expressed her desire to learn from her how to successfully lead, and they have developed a mentorship. They acknowledge their differences, but have many conversations that exchange ideas and insights about how to be successful in a leadership role, including some innovative ideas for change shared by Christina. 

Millennials as managers

You may experience a millennial nurse as your manager. Or, as a millennial, you will most likely desire an upward movement in your career. Remembering some of the differing values and communication preferences held among the generations may be helpful. (See Generational differences.)

Christina obtained a new role as the assistant manager of an emergency department. She is receiving positive feedback from her staff and increased collaboration among staff to help improve their practice environment. Many have commented that she is helping them become more satisfied in their role and workplace relationships. 

It’s important to remember that not all individuals follow the characteristics of their generational cohort. The values and beliefs are generalizations of the whole; each person is still an individual, so exploring their personal feelings and concerns is still recommended.

Stephanie M. Chung is an adjunct professor at Kean University in Union, New Jersey and is currently enrolled in the PhD in nursing program. She is a proud millennial.

If you are interested in more information on leadership roles or just have a question, ask one of our Nurse Leaders!

Selected references

Pew Research Center. Millennials overtake Baby Boomers as America’s largest generation. April 25, 2016.

Shaw H. Sticking Points: How to Get 4 Generations Working Together in the 12 Places They Come Apart. Carol Stream, IL: Tyndale House Publishers; 2013.

If you’re an Emergency Room Nurse, you may have some things to add to this list. If you’re in Nursing school or considering changing your specialty to ER, this information may be helpful to you. 

As a recent patient in the ER, I was amazed at the composure of the ER Nurses and the way they handled the chaos around them. While in the ER, there was an individual constantly complaining about how long he had to wait to be seen. Every Nurse was kind to him even though he was annoying everyone else waiting to be seen. With everything going on around them, I saw that every Nurse was professional and focused. Emergency rooms couldn’t exist without the expertise, professionalism, attention to detail, and compassion of the Nurses in the ER department.

1. Unlike most specialists, you need to know how to treat people of all ages and needs. Emergency nursing is considered a nursing specialty, but we’re also generalists. We take care of children and the elderly, pregnant patients and psychiatric patients, patients with special needs — you name it, we do it. It’s essential to regularly brush up on medical information and keep current in your continuing education, because you have to be prepared for any kind of patient to walk through the door.

2. Deciding who to treat first is really, really hard. We do get the stereotypical “emergency” cases — heart attacks or trauma victims — but we also see patients who are not able to get care from a primary care physician. A triage nurse will do an “across-the-room survey” to see who needs to be seen immediately and who can wait a little longer. In most emergency departments, only experienced nurses [with] advances certifications perform triage.

3. Multitasking is essential. You need to think fast on your feet, because you never know what’s you’re going to be asked to do next. One minute, you might be drawing blood or starting IVs; next, you’ll be checking on someone’s vital signs; then you might have to perform CPR on someone. Fortunately, there are many safety mechanisms in place to catch potential errors. For example, before we give a patient medication, we scan both the patient's ID band and the medications to make sure it’s the correct one, [and] we’ll do a targeted medical history, and review current medications and allergies to make sure there are no problems.

4. It’s way more work than it looks like on paper. Traditionally, nurses work 12-hour shifts, three shifts a week. It’s less than a 40-hour workweek, but it’s still exhausting: There’s virtually no downtime and you’re physically on your feet, running around during the entire shift. I wear a FitBit and I can easily put on 5 miles in a single day. In my institution, we also have on-call times, so you have to sign up for so many hours of on-call every six weeks — beyond your regular shifts — and be prepared to go into work at a moment’s notice.

5. You’re a nurse no matter where you are, even when you’re off the clock.When people know you’re a nurse, everyone wants to know if you can take a look at their rash or help them heal a cut or tell them how to get over a cold. A couple weeks ago, I was on an airplane and wound up taking care of a passenger who was having difficulty breathing after the flight attendants asked if there was a medical professional on board.

6. You will become fanatical about your loved ones' safety. I’ve seen a lot of things come through the ER doors, and a lot of injuries could’ve been prevented. For instance, we treat people who were in car crashes but didn’t have their seatbelts on, or children who were not in their car seats, or bicyclists and motorcyclists who weren’t wearing helmets. All of those injuries can be prevented.

7. Emergency departments don’t always hire nurses straight out of school. The reason is that new nurses take upward of six months to get oriented, so that basically means six months of training before a brand new nurse can start working. Some ER nurses start off in intensive care, telemetry, or maternal child health to gain experience before applying to work in the emergency department. Another way to get a foot in the door is to start as an ER department tech, which offers on-the-job training and can give you the experience you need to be an ER nurse. Some nursing students also do a preceptorship, where you can shadow a nurse for a few months while you’re still in school. I’ve taken on students for preceptorships and several of them have been hired in the end, so it’s a good way to make connections and prove you can do the job.

8. Sometimes, patients will treat you like a punching bag. There’s a lot of what we call “violent verbal abuse” in our department. Patients might call you names, or take out their frustrations by yelling at you. I think everybody just has to put on their armor before coming to work but it does affect you. It helps to be part of a professional association where you can vent to other nurses at the end of the day, or just talk it out with somebody who understands the environment.

9. You will have to learn how to deal with death. These days, especially with medical technology, we’re saving more and more people due to the advances in healthcare. But you will also see the cardiac arrest who can’t be saved, or the person who has such bad trauma that they bleed out. Death is part of the territory but nothing can really prepare you to watch one of your patients die. The hardest cases are when the patient is young. When you see something really upsetting, that’s where you lean on your network of other nurses. It’s so helpful to talk about what happened with someone else who understands.

10. Just being there with a patient, or patient’s family, can be healing. Most people, when they come to the emergency department, it’s not a planned visit. Patients and their families are dealing with a lot of anxiety and stress, and we have the opportunity to be there when people are most vulnerable. Just being there, holding their hand — that can go a long way.

Though discrimination exists in many forms, racial discrimination brings a unique set of implications that threaten the mental and physical health of patients and acts as a barrier to seeking care from medical professionals. Eliminating racism, therefore, is not just a concern for civil rights activists, but also for medical professionals.

Whether it’s the mere anticipation of discrimination, or violence as a manifestation of prejudice, racism has negative impacts on the mental and physical health of its victims, including “increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality.” A study in the American Journal of Public Health found that perceived discrimination influences lifestyle decisions like overeating, internalizing aggression, and developing poor coping strategies that impact long-term health.

These lifestyle choices are part of a vicious cycle that can be influenced by social determinants of health, which are “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not,” according to Healthy People 2020.

One study found that racism experienced by minority communities increased vulnerabilities to social and environmental factors that contribute to health, like access to health care and income level. The National Association of Social Workers found that these social determinants of health also include “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.”

In addition to affecting long-term health, social determinants can be barriers in seeking quality health care, and can lead to poorer outcomes after treatment. Many minorities cite racial discrimination as a primary barrier to seeking health care — particularly treatment for mental health issues. In a survey of adults who experienced an unmet need for mental health treatment in the past year, respondents across all racial group cited discrimination as a primary barrier to seeking treatment. Nearly a quarter of respondents said they anticipated negative stigmas surrounding treatment to impact relationships and employment circumstances.

As key resources in patients’ access to quality primary care, health care professionals, like Family Nurse Practitioners, must understand these implications of racial discrimination among other social determinants, and mitigate harmful, pervasive effects through opportunities like these:

• Advocating for awareness: Nurses, as they interact with patients closely and regularly, can be advocates for patient needs, as they help identify key social determinants that leave patients vulnerable to the systemic racism. Public health advocates can also reach out to minority communities to help them understand the importance of physical and mental health.
• Treating mental health as primary health: Integrating behavioral health care screening and treatment can help patients make better use of clinic visits and resources they might not otherwise be able to access. This increased access can reduce health disparities and increase effectiveness of treatment.
• Promoting cultural competency: A diverse nursing staff can improve cultural competency — being conscious of social and cultural differences — and increase quality of care to underserved groups. By valuing diversity, nurses and other health professionals can take pivotal steps in ensuring access to care for an increasingly diverse patient population.

An integrated approach to mitigating discrimination can address both the causes and effects of its impact on accessing quality care. This means nurses should work together with other health practitioners, social workers and educators to understand and identify at-risk patients and appropriate strategies. Above all else, the goal is to help patients feel safe, understood and heard when seeking health care or treatment.

As a Nurse you must be compassionate and sometimes you need to deliver hard news to a patient. No one can truly understand what someone goes through unless they have walked in the same shoes. Lindsay Norris had given heartbreaking news to patients many times as an Oncology Nurse but never knew exactly what her patients felt about the news until she got the news herself. She then wrote a letter addressed to every single one of her patients. See what this Nurse had to say.

“Dear every cancer patient I ever took care of, I’m sorry. I didn’t get it.” That is the title of the open letter oncology nurse Lindsay Norris wrote for her blog, Here Comes the Sun 927.

Norris penned the powerful piece on November 14, two months after she was diagnosed with stage III colorectal adenocarcinoma. “I didn’t get what it felt like to actually hear the words,” the 33-year-old from Olathe, Kansas, admitted in her note. “I didn’t get how hard the waiting is … I didn’t get how awkward it was to tell other people the news … I didn’t get the mood swings … I didn’t get that it hurts to be left out.”

“I didn’t get why you were always suspicious. You couldn’t help but wonder if [the doctors] all knew something you didn’t about your prognosis,” the mom of Harrison, 3, and Evelyn, 7 months, revealed. “We shared the percentages and stats with you — and that every cancer is different … but still — is there something more? Something they were protecting you from or just felt too bad to tell you? Logically, I know the answer to this but find myself with these feelings as well. I’m sorry. I didn’t get it.”

But Norris’ greatest regret? “I didn’t get how much you worried about your kids,” she wrote. “I should’ve talked to you more about them — and not just in terms of lifting restrictions or germs. You worried about how this was going to affect them. You worried about not being able to keep up with them or care for them properly on your bad days. You worried they’d be scarred and confused. You worried about leaving them. I’m sorry. I didn’t get it.”

The oncology nurse, who is currently undergoing oral chemotherapy and radiation, has been leaning on her husband of four years, Camden. “You felt thankful when your spouse would say, ‘Go get some rest and I’ll take care of the kids,’ but your heart hurt overhearing them play in the other room away from you, wondering if that was a glimpse into their future that didn’t have you in it,” Norris mused in her letter. “I’m sorry. I didn’t get it.”

Norris tells Us Weekly she’s learning to accept help — a topic she touched upon in her blog. “A few weeks ago I woke up feeling quite ill. This was still when I was insisting on bringing my kids to school myself,” she tells Us.“Halfway there I had to stop at a gas station to get sick. We went in the restroom, and we didn’t even make it in the door before I threw up. Of course my 3-year-old was concerned and asking a million questions. I felt pretty pathetic. I think it was just the first time I had to admit to myself that my treatment was affecting me.” Ever since then, Camden, 37, has been shuttling Harrison and Evelyn to school and daycare.

Meanwhile, Norris is focusing on what’s good. “Thanksgiving was a really nice day for me. Staying home with my little family with no plans felt amazing. Camden made a little turkey and stuffing for dinner,” she tells Us.“When I asked Harrison what he was thankful for, he answered, ‘God, my best friend Cooper, milk and my sissy.’ The future may not be promised, but when I look around, the view is beautiful.”

Discrimination in the United States has historically cut a wide swath across a number of demographics, including race, gender, ethnicity, sexual orientation, age, disability and religion. Despite a major cultural and political shift through the implementation of the long overdue Civil Rights Act of 1964 and other efforts at fighting discrimination, we still see it today — particularly in the form of modern-day racism. According to the National Association of Social Workers (NASW), racism is “the ideology or practice through demonstrated power of perceiving the superiority of one group over others by reason of race, color, ethnicity, or cultural heritage.”

Though all discrimination is harmful, an examination of the effects of racism — the most commonly studied and cited form of discrimination — reveals implications for the mental and physical health of individuals and communities that can be applied to other types of discrimination. Racism, therefore, is not just a civil rights issue, but also a public health concern.

As key figures in addressing such consequences, health care professionals, such as Family Nurse Practitioners, must recognize the health implications involved and know the steps they can take to help stop discrimination and mitigate its negative outcomes.

Impact of Discrimination on Health

The NASW says racism results in “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.” Some of these factors can be classified as social determinants of health (SDOH), which have a major influence on health outcomes. According to Healthy People 2020, SDOHs are defined as “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not.” 

In one study of the health effects of discrimination on black and white communities, SDOHs were defined as a critical factor, since populations that lack appropriate resources are affected the most: “On average, black adults typically experience more health risks in their social and personal environment than white adults (including higher poverty and lower-quality medical insurance), they may be especially vulnerable to negative health effects as a result of racial discrimination." 

There are a number of physical and mental health effects related to discrimination, including increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality. According to a study published in the American Journal of Public Health, “Merely anticipating prejudice leads to both psychological and cardiovascular stress responses. These results are consistent with the conceptualization of anticipated discrimination as a stressor and suggest that vigilance for prejudice may be a contributing factor to racial/ethnic health disparities in the United States.” Additionally, discrimination has been found to impact lifestyle decisions that affect health long after the experience is over.

Communities at highest risk for discrimination are the same communities that are perpetually marginalized by the negative impact of SDOHs. In a 2013 Atlantic article titled “How Racism is Bad for Our Bodies,” writer Jason Silverstein points out that the cyclical effect of discrimination on health is what epidemiologist Nancy Krieger refers to as “embodied inequality,” which creates poor health outcomes that are often passed down through generations. This results in a vicious cycle where the sickest and poorest among us are more likely to remain sick and poor.

Solutions and Strategies

Health care professionals and policymakers can play a key role in curbing discrimination by supporting legislation and policies that address these issues, such as the U.S. Department of Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities. The U.S. Office of Minority Healthprovides a summary of this action plan, and serves as a “one-stop source for minority health literature, research and referrals for consumers, community organizations and health professionals.” Through use of such resources, and appropriate support networks, victims of discrimination can find the support they need to exercise their rights and end the various forms of discrimination they may be vulnerable to.

Additionally, it is essential that health care professionals work to better recognize the effects of discrimination by taking SDOHs into consideration as part of their approach to care, understanding which populationsmay be at greater risk for discrimination, screening for negative health outcomes that may be a direct result, and ensuring that discrimination is not occurring within their own practice settings. Providing access to necessary resources and additional support for these patients is critical.

Implications for FNPs

Family Nurse Practitioners are integral to comprehensive care for all patients, and serve as a key resource for those most vulnerable to discrimination’s negative effects on health. “At the University of Southern California Department of Nursing in the School of Social Work, we are teaching our students about the central importance of social determinants of health, with racism being a key determinant, in the health of individuals and families,” said Ellen Olshansky, Professor and Chair of Nursing at USC School of Social Work. Although the policy statement by the American Nurses Association, “Discrimination and Racism in Health Care,” dates to 1998, its principles are just as relevant today, addressing both the health care environment and the patients who are served:

ANA believes it is critically important for Americans to come to a shared understanding of the negative consequences of discrimination and racism which still pervades our society and be willing to take individual as well as collective actions to bring America closer to our ideal of equality and justice. Equality and justice must also extend to other minorities such as the aged and disabled. Health care that is individualized to the health practices and specific needs of each person and/or population group is vital to maintain and improve the health of all Americans.