by Katie Davis, RN, BSN, MS-HSM
Director, Nursing Programs

Picture this scene: a nurse in her 50s attends to an ED patient who is suffering a seizure. The nurse successfully uses a time-tested approach to treat the patient. Her 20-something colleague observes her actions and compliments the older nurse’s quick thinking and judgment call. The millennial nurse then proceeds to suggest an alternative method she recently learned in nursing school. This remark slightly annoys the nurse who has worked 30-plus years in health care. After all, she has used this approach countless times with much success—before her younger counterpart even started high school.

We often hear from our Nurse Residency Program members that working with different generations is one of their greatest challenges. Each generation has been shaped by different experiences (the Great Depression versus the recent Recession), defining events (the Vietnam War versus Desert Storm), technology (rotary phones versus Smartphones) and values (hard work versus instant gratification). In my research on this topic, the resounding theme is that we need to understand where each generation comes from to ensure that we create an environment where five generations can work cohesively side by side.

Defining each generation

Traditionalist nurses (1925-1945). Shaped by World War II, this group is considered disciplined, loyal and hardworking. Although most have retired, there are still a few working primarily as part-time nurses. In a clinical setting, traditionalist nurses value quality, structure, following rules and procedures.

Baby boomer nurses (1946-1964). The “Woodstock” generation are considered loyal, appreciate delayed gratification and feel that overtime is a moral obligation. Baby boomer nurses also lean towards teamwork, cooperation and buy-in. They make up 50 percent of the nursing workforce today, but will soon be retiring within the next 10 years.

Generation X nurses (1965-1976). This generation was born during a period of rapid change; they grew up with video games, household TVs and are very supportive of technology. They appreciate work-life balance over higher salaries, and nurses in this age bracket find quality of life to be very important.

Millennial nurses (1977-2000). Shaped by Columbine High School shooting and Sept. 11 terrorist attacks, they are involved in many after-school activities and strive for balance between work and home. Like Gen Xers, millennial nurses are tech savvy and grew up with the Internet.

Xennial nurses (1977-1983). This ‘micro-generation’ sandwiched between Generation X and millennials may have been hit hardest by the recession because of a combination of student loan debt, job losses and other factors. They are leery of authority figures and do not like to be micromanaged, favoring to work independently.

Strategies to engage

Now that we have taken a look at each generation, let’s see what type of approach could be used to get all five nursing groups working together. Here are some steps you can take to align your workforce regardless of age.

  • Take a generational inventory of your workplace
    • Understanding the generational makeup of your workforce can guide nurse leaders in structuring the work environment to accommodate different generational cultures
  • Encourage feedback and group communication; identify mutual team goals
    • Communication preferences across generations are important to take into consideration. For example, when communicating with veteran nurses, it may be best to have a conversation in person or in writing, instead of opting to communicate using technology
  • Ensure each generation is represented in hospital committees
    • If you are exploring change or implementation of any policies or procedures, solicit input from nurses that represent the generational profile of your organization to ensure that all points of view are considered
  • Tailor coaching and motivating to each generation
    • Each generation may be motivated by different things: time off, salary, recognition. Work to find out what incentives will increase productivity for your team. According to, some millenials like new projects which make them feel they have a purpose at their job, while baby boomers want credit and compensation for their hard work.
  • Withhold judgment and learn from the differences
    • Before jumping to conclusions about each generation based on past experiences or stereotypes, wait and see what nurses from each generation can contribute to our profession. Each generation has a wonderful and unique experience they bring to the table.

Also, remember to think outside the box to ensure that your staff is being heard–across all generations, as this chief nursing officer did. She meets quarterly with a millennial mentor and they both leave with a to-do list. Changes within their organization have been implemented as a result of this relationship, and staff engagement has improved.

Take time to understand how each generation is defined and how that manifests itself in your nursing staff and the result will be happier and more productive teams.

About the author. Katie Davis works with the Vizient/AACN Nurse Residency Program, supporting the nursing program team with training and data interpretation for members engaged in the Nurse Residency Program. Davis also directs coordination and oversight of training and educational offerings for participants of nursing leadership programs and services. Davis previously worked as a collaborative advisor in the Vizient Performance Improvement Collaborative department, as well as a product specialist, where she worked with academic medical centers and their affiliates participating in the Clinical Database and Resource Manager.

Published: December 14, 2018