Diane R. Andrews, PhD, RN Assistant Professor UCF College of Nursing

1. The Relational GenerationExpectations of Millennial Student Nurses Preparing to Transition into Practice Diane R. Andrews, PhD, RN Assistant Professor UCF College of Nursing The 2012 National State of the Science Congress on Nursing Research September 14, 2012 Washington, DC

2. This study was supported through intramural funding provided by UCF College of Nursing

3. Why Study New Grads? • Shortages and Retention • New Generation/New Values • Turnover • Expectations Unknown

4. Purpose: Identify Expectations What do new graduate nurses expect as they transition into the workforce and what might be the impact?

5. Method Qualitative descriptive design BSN students Semi-structured, open-ended questions Interviews, recorded, transcribed Data analyzed and coded

6. Findings • Expect transition will be stressful • Expect a safety-net of support • Expect respect and acknowledgement

7. Stressful • Self-doubt regarding knowledge and competency • Worried about independent decision-making • Worried about “Being Judged” • Patients and Families • Physicians

8. “I’m so used to having a preceptor or having an instructor there that the thought of me doing it on my own kind of scares me a bit.”

9. Safety-net Expect safety-net of support … • Orientation and preceptor support

10. “I expect to be in the role of graduate nurse. And I expect to have a preceptor. And I expect not to be put in positions that I am not supposed to be put into.”

11. Safety-net Expect safety-net of support … • Orientation and preceptor support • Colleague support

12. “I would just hope they would view me as a peer from the beginning.”

13. Safety-net Expect safety-net of support … • Orientation and preceptor support • Colleague support • Supervisor support • Family support

14. Respect & Acknowledgement • Collegiality • Teamwork

15. “I would hope they would view me as a peer from the beginning. I mean even though I’m just beginning it’s “I’m doing the same work you know. Just learning as I go.” So I’d hope to be viewed maybe as a peer, or like a younger peer, from the beginning.”

16. Expectation vs. Reality Anticipatory stress related to confidence and competence … • Anticipatory stress well documented • Residency programs lead to improved skill with delegation, prioritization, managing patient care delivery, autonomous decision-making, collaboration, conflict resolution and constructive use of feedback.

17. Expectation vs. Reality Supportive relationships …. • Multiple reports of incivility in the workplace • Age/generational differences precipitate. misunderstanding and affect unit culture. • Inappropriate use of power in assessment of new graduates is a source of conflict.

18. Expectation vs. Reality Collaborative teamwork … • The expectations of Millennials for collaboration and teamwork is inconsistent with the work values of previous generations. • Nurse/Physician collaboration remains a challenge.

19. Implications • There is evidence that residency and preceptor programs address the known stressors. associated with competence and confidence. • Participation in such programs has been demonstrated to improve short-term retention. • Programmatic intervention.

20. Implications • The expectations of transitioning nurses related to supportive relationships and collaborative teamwork are associated with unit culture. • Unit culture is associated with job satisfaction and stated intent to leave. • Organizational interventions to meet the expectations of new graduates need to be addressed. • Healthy work environment critical.

21. References American Association of Colleges of Nursing (2012) Executive summary of the post-baccalaureate residency program. Available at: http://www.aacn.nche.edu/education-resources/nurse-residency-program (accessed 2 July 2012). Andrews DR, Burr J & Bushy A (2011) Nurse’s self-concept and perceived quality of care: A narrative analysis. Journal of Nursing Care Quality 26(1), 69-77. Auerbach DI, Buerhaus PI & Staiger DO (2011) Registered nurse supply grows faster than projected amid surge in new entrants ages 23-26. Health Affairs 30(12), 2286-2292. Bowles C & Candela L (2005) First job expectations of recent RN graduates: Improving the work environment. Journal of Nursing Administration 35(3), 130-137. Buerhaus PI, Staiger DO & Auerbach DI (2009) The future of the nursing workforce in the United States: Data trends and implications. Boston: Jones & Barlett.

22. References Candela L & Bowles C ( 2008) Recent RN graduate perceptions of educational preparation. Nursing Education Perspectives 29(5), 266-271. Carver L & Candela L (2008) Attaining organizational commitment across different generations of nurses. Journal of Nursing Management 16, 984-991. Cubit KA & Ryan B (2011) Tailoring a graduate nurse program to meet the needs of our next generation of nurses. Nurse Education Today 31, 5-71. Duchscher JEB & Cowin L (2004) Multigenerational nurses in the workplace. Journal of Nursing Administration 34(11), 493-501. Duchscher JB (2008) The process of becoming: The stages of new graduate professional role Transition. The Journal of Continuing Education in Nursing 39(10) 441-450.

23. References Fink R, Krugman M, Casey K & Goode C (2008) The graduate nurse experience: Qualitative residency program outcomes. Journal of Nursing Administration 38(7/8), 341-348. Fry ST, Veatch RM, & Taylor C. (2011) Case studies in nursing ethics (4th ed.), Jones Bartlett Learning: Sudbury, MA. Kalisch BJ, Lee, H & Rochman M (2010) Nursing staff teamwork and job satisfaction. Journal of Nursing Management 18, 938-947. Kovner CT, Brewer CS, Fairchild S, Poornima S, Kim H & Djukic M (2007) Newly licensed RNs’: Characteristics, work attitudes, and intentions to work. American Journal of Nursing 107(9), 58-70. Kramer M, Maguire P, Halfer D, Budin W, Hall D, Goodloe L, Klaristenfeld J, Treasley S, Forsey L & Lemke J (2012).The organizational transformative power of nurse residency programs. Nursing Administration Quarterly 36(2), 155-168.

24. References Laschinger HKS, Finegan J & Wilk P (2009) New graduate burnout: The impact of professional practice environment, workplace civility, and empowerment. Nursing Economics 27(6), 377-383. Laschinger HKS (2008) Effect of empowerment on professional practice environments, work satisfaction and patient care quality: Further testing the nursing worklife model. Journal of Nursing Care Quality 23(4), 322-330. Lavoie-Temblay M, Paque M, Duchesne M, Santo A, Gavrancic A, Courcy F, & Gagnon S (2010) Retaining nurses and other hospital workers: an intergenerational perspective of the work climate. Journal of Nursing Scholarship 42(4), 414-422. Manion J (2009) Managing the multi-generational nursing workforce: Managerial and policy implications. Geneva, Switzerland: International Centre for Human Resources in Nursing.

25. References McKenna B, Smith NA, Poole SJ, Coverdale JH (2003) Horizontal violence: experiences of Registered Nurses in their first year of practice. Journal of Advanced Nursing 42(1), 90-96. Mills JF & Mullins AC (2008) The California nurse mentor project: Every nurse deserves a mentor; Nursing Economics 26(5), 310-315. National Council of States Boards of Nursing (NCSBN) (2011) Transition to practice. Available at: https://www.ncsbn.org/363.htm (accessed 2 July, 2012). Ng ESW, Schweitzer L, Lyons ST (2010) New generation, great expectations: A field study of the millennial generation. Journal of Business Psychology 25, 281-292. Olson ME (2009) The “Millennials”: First year in practice. Nursing Outlook 57, 10-17.

26. References Oermann MH, Poole-Dawkins K, Alvarez MT, Foster BB & O’Sullivan R (2010) Managers’ perspectives on new graduates of accelerated nursing programs: How do they compare with other graduates? Journal of Continuing Education in Nursing 41(9), 394-400. Pellico LH, Brewer CS, Kovner CT (2009) What newly licensed registered nurses have to say about their first experiences. Nursing Outlook 57, 194-203. Peterson J, McGillis-Hall L, O’Brien-Pallas L & Cockerill R (2011). Job satisfaction and intentions to leave of new nurses, Journal of Research in Nursing. 16(6), 536-548. PricewaterhouseCoopers (2008) Managing tomorrow’s people - Millennials at work: Perspectives from a new generation. Available at: www.pwc.com/managingpeople2020 (accessed 2 July 2012).

27. References Sandelowski M (2000) Whatever happened to qualitative description? Research in Nursing and Health. 23, 334-340. Smith LM, Andrusyszyn MA & Laschinger HKS (2010) Effects of workplace incivility and empowerment on newly-graduated nurses’ organizational commitment. Journal of Nursing Management 18, 1004-1015. Stanley D (2010) Multigenerational workforce issues and their implications for leadership in nursing. Journal of Nursing Management 18, 846-852. Ulrich B, Krozek C, Early S, Ashlock CH, Africa LM & Carman ML (2010) Improving retention, confidence, and competence of new graduate nurses: Results from a 10-year longitudinal database. Nursing Economics 28(6), 363-375. Unruh LY & Nooney J (2011) Newly licensed registered nurses’ perceptions of job difficulties, demands and control: Individual and organizational predictors. Journal of Nursing Management 19, 572-584.

28. References U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) (2010) The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Available at: http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurveyfinal.pdf (accessed 2 July 2012). Wieck KL (2003) Faculty for the millennium: Changes needed to attract the emerging workforce into nursing. Journal of Nursing Education 42, 151-160. Wolff AC, Ratner PA, Robinson SL, Oliffe JL & Hall LM (2010) Beyond generational differences: A literature review of the impact of relational diversity on nurses’ attitudes and work, Journal of Nursing Management 18, 948-969.

29. Thank-you Questions ….