The Culture of Nursing

The culture of nursing has shifted to support the many generations in the workplace. How does nursing leadership respond to this shift and drive the profession forward? Nurses Announcements Archive Article

The Culture of Nursing

Nursing leadership is faced with a very challenging dilemma. In order to drive the profession forward, those in the workforce for many years must adapt to changes in technology and systems while integrating their bedside practice to support an ample amount of time completing all the daily requirements of the job. Newer nurses must learn how to use their technology skills, yet learn to interact at the bedside, again finding the same balance.

Nursing leadership has been tasked to move the profession forward thru education, certification, improved outcomes, and patient satisfaction. Today's nurse must use a variety of tools in order to meet the many needs of the patient of today's standards. The patient has shifted to a customer, where rankings and number of stars can help determine where you wish to receive healthcare services. The new nurse must maintain professional integrity while ensuring customer satisfaction. This concept has lead to job dissatisfaction in terms of the customer is always right, yet the medical staff receive all the training.

The new nurse takes this responsibility in a mannerism that chooses movement, rather than sustainability. Many hospital cultures are facing new nurses entering the workforce who move around frequently. The dedicated old school nurse is far and few in between. The new nurse moves around, gains experiences, and leaves the dedication once viewed as the hallmark of nursing, at the door. The nursing leader must find new methods to motivate, entice, and keep the new nurse engaged and focused in their current practice. As we grow the nursing graduate into a productive nurse, another organization is willing to do the same in a specialty areas. New nurses are finding themselves in environments they may not be prepared for. It is nursing leadership's challenge as a profession to ensure we grow nurses up correctly and accurately prepare them for whatever environment we hire them for.

It is important for leaders to communicate and network to ensure this new generation of nurses does not fall thru the cracks and just move around the profession. We must give them feedback, teach them, mentor them, and not allow them to move into situations they are unprepared for. As customer and patients expectations increase, we seem to have decreased are standards as a profession. By this, we must have policies in place that require minimal experiences and practice encounters before moving around a facility.

This new generation of nursing enters the workforce and after 6 months feel they have the experience to move around. It seems thru the lens of nurse manager, that the plateau affect takes place quickly for many nurses. Mastering a medication pass and charting system seems to be the motivator to judge their readiness to more critical situations. The old school nurse experiences many situations over years of loyal service, allowing them to handle just about anything thrown at them in today's environment. The new nurse lacks the critical thinking and nursing judgement to handle many situations. As hospital's increase their speed of processes, the new nurse struggles to keep up.

I often hear, I had to care for 8 patient's today. This means learning the history and personality of 8 patients during an 8 hour shift on the floor. We discharge patients home much quicker tan just 5 year ago, while emergency rooms flood with those needing to be admitted. The new nurse must learn more than skills and tasks. This constant turnover and lack of longevity, takes away from the overall experiences and ability to problem solve that the older generation nurse has. It is important for the new nurse to learn the whole system, the complete patient experience.

We as nurse leaders must expose the new nurse to the complete patient experience while asking for their dedicated service to learn and gain knowledge. This is not just a job that pays the bills. This is not just a job that can give you the knowledge to be hired in a new area once the old area feels less enticing. We must force nurses to stay put and learn and grow rather than allow them to move around thinking they have the experience and knowledge to be successful in new environments.

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JohnG77

About JohnG77, BSN, MSN, RN

John Green, RN, MSN Nurse Manager 46 Bed Medical Unit

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Specializes in NICU, ICU, PICU, Academia.

You say 'not allow' a lot. This is troubling. This might explain your apparent turnover problem as well.

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Specializes in Hospice.

The red flag here: "We must force nurses to stay put ..."

OP, your approach to the problem of retention kind of gives me the willies.

Who is the "we" doing all that forcing and driving and not allowing?

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Specializes in M/S, Pulmonary, Travel, Homecare, Psych..

I have to respectfully disagree.

Much is said about the shortcomings of the "Information Age" generation. I agree with some of the criticisms even. I also see things in them that I wish I had at their age. One of these things is their willingness to remove themselves from bad situations. It seems they have the ability to overcome the fear of change that binds older generations. I've also noticed they are able to execute their exit gracefully. My generation seems to relish making it a screenplay drama. These are just my personal observations though.

You say: "We must force nurses to stay put and learn and grow rather than allow them to move around".

I hear: "We must make our younger nurses submit to unsafe and unhealthy work environments by trumpeting what the healthcare administration tells us to say (that it's for the sake of learning and growth)".

The flaw I see in your logic is: Too many healthcare providers leave us in a state of being short staffed and unsupported. There is no learning and growth going on there. Moving on to better horizons is the only option they have if growth and learning is the goal.

I admire your gusto, but believe your efforts are aimed at the wrong crowd.

For me, instead of expecting the nurses to accommodate poor work environments and "stay put", I think we as a profession would benefit more by being the catalyst for change in the healthcare industry. For starters, doing away with the ridiculous survey scores you mentioned would be a good start. Healthcare and retail are too different to use the same measuring tools for them both.

I'm a big proponent of voting with your feet and I believe the new generation of nurses entering the field are using their rights to do so quite nicely. If anyone doesn't like it, they are well within their rights to change things to make staying more enticing.

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Specializes in Oncology; medical specialty website.

I would prefer thinking of nurses with many years of experience as "experienced nurses" rather than the pejorative "old school nurse." Nurses with many years of experience are using technology too.

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Specializes in NICU, ICU, PICU, Academia.
I would prefer thinking of nurses with many years of experience as "experienced nurses" rather than the pejorative "old school nurse." Nurses with many years of experience are using technology too.

I want to like this more than once.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

WAY too must use of the words, "must" and "force". I don't like the tone of your article one bit.

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OP does make a point. As an almost 30 year nurse in my field, I knew my job inside out and was able to thrive with the changes, the job changers leave with frustration and self justification before they're proficient.

Theoretically, if we had a whole team with significant experience and longevity in their dept with a rare newbie being introduced, that unit would out perform any with a revolving door. The fix to high turnover is no turnover.

Some places are just terrible and I don't know how to stop turnover altogether but I sure am trying in my tiny corner of the world.

As far as surveys mentioned upthread, I'm not sure how nursing as a group can realistically do away with them.

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I agree with the OP that new nurses often lack critical thinking abilities and nursing judgement to handle many situations. I think a big part of the problem in health care today is that a number of facilities have "downsized" the more highly paid, experienced, often older nurses, and have concentrated on hiring young, inexperienced nurses, so that the work force is lacking in knowledgeable, experienced nurses. I see this in the ER when I have gone there with family members; the nurses are mostly young and don't seem to really know what they're doing, and don't seem to be using critical thinking or using the Nursing Process. This pruning of the experienced nurses isn't the newer, inexperienced nurses' fault, but they suffer the consequences if not enough experienced and knowledgeable nurses are available to provide guidance and assistance.

The question is how to provide a work environment that supports inexperienced new nurses and helps them develop into highly competent experienced and knowledgeable nurses, and how to retain these nurses as employees. Using language in your post that speaks of "forcing, driving, and not allowing" the new nurses is not the way to encourage staff to remain at your place of employment. Nursing is not the military, and you are not a military officer. I suggest rethinking your post and thinking hard about what your management team is doing. Also, do a search on this forum for articles by some hospital/former hospital executives who have posted some very informative articles and have spoken about successfully retaining nurses.

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I think that the solution is not to force new nurses to stay put and "force them" to grow. Leadership has to realize that patients are not "consumer" in the retail sense (although CMS may suggest something else by well meant but poorly executed improvement towards patient centered care) and that nurses are not just numbers and bodies to fulfill a variety of tasks everybody without mistake and high quality of care.

If you want nurses to stay you need to provide an environment in which all healthcare professionals can actually do their job without the feeling that they have no time for critical thinking, will loose their license any minute, and so on and forth.

It sounds that you are not up-to-date with current changes yourself. Nowadays people have to be mobile and younger generations value a work life balance, they do not view their job as something that has priority over everything else. People feel free to start a job but if it is not for them they move on. No employer shows loyalty either - they let people go who have worked a long time if it fits their financial needs or let nurses go for minor mistakes if they need a scape goat. People move around all the time - allowing them to move within the company might be better as opposed to forcing them to look outside if they want a change or advance.

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Specializes in orthopedic/trauma, Informatics, diabetes.

I served on a nursing retention committee that was comprised of nurses practicing 15 years. It was an interesting experience. Many of us wanted the same things (safe staffing, more money and better benefits). As a member of the

I think the OP's choice of working about "making" them stay put is not as accurate as trying to find ways to make them WANT to stay.

We came up with some ideas in the retention meetings and upper management actually listened and implemented some change. Maybe not enough, but they are trying.

I tend to be optimistic, I like my job, I want others to like their job and stay. I want to help promote retention. I know there are challenges, but would rather try to fix things than give up an go somewhere else. I am old enough to know that the grass is not greener....

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Nowadays people have to be mobile and younger generations value a work life balance, they do not view their job as something that has priority over everything else. People feel free to start a job but if it is not for them they move on. No employer shows loyalty either - they let people go who have worked a long time if it fits their financial needs or let nurses go for minor mistakes if they need a scape goat. People move around all the time - allowing them to move within the company might be better as opposed to forcing them to look outside if they want a change or advance.

Bravo, agreed. I straddle the line between "older nurse" and "younger nurse" in that I'm a gen xer but have many years' experience. So I'm technologically savvy, have the critical thinking skills, but have walked away from more than one bad work environment without so much as a backward glance. I feel no loyalty to any company or organization, my loyalty lies with my family and myself. Period.

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