Optimal Utilization of the Multi-Generational Nursing Workforce

1. Optimal Utilization of the Multi-Generational Nursing Workforce By Jeff Carameros RN, BSN, DNP resident University of Central Florida

2. Root of the concern • Current and prior research shows the increasing prevalence that the national shortage of nurses. • As this has been publicized, we have seen an influx of future nurses, but this continues to be less than is required to recover from a workforce shortage. • Seasoned nurses are privy to this and have shown to be staying in the work force longer, possibly in an effort to prevent decline of patient care.

3. Problem at hand • With the dilemma of an increasing shortage of qualified nursing personnel, there has been a broadening of both the age range and experience levels in practicing nurses. • Nursing leaders are faced with this issue and are tasked to most effectively utilize such a diverse group of nursing staff.

4. History of the problem • The current nursing workforce shortage was first identified in 1995 (Atwater & Jones, 2004). • Adding to the complications of the shortage was the increasing acuity of inpatient care and the increase in both home care and assisted living situations that both pulled from an already thinned pool of current nurses.

5. History continued • Resulting from these factors was a dilemma in nursing leadership. • Nurses ranging in ages from early twenties to sometimes their early seventies were working side by side with comparable responsibilities in patient care that drew upon multiple generations of personal influence as well as multiple generations of education.

6. History continued • In spite of the widening are range of the prospective nursing workforce, there is also the fact that experience levels varied tremendously because initial nursing education was being obtained during second and subsequent career choices.

7. Opportunities for nursing leaders • Nursing managers and leaders who oversee the care provided by staff nurses are faced with the challenge of integrating the knowledge and experiences as well as the strengths and weaknesses of such a varied workforce in order to provide the most optimal outcomes for both the patient, the nursing staff, and the healthcare organization.

8. Resources for nursing leaders • Since the goal nursing is to move toward an evidence based approach to practice, it would be prudent to evaluate these resources in order to incorporate previously proven nursing theories into obtaining desired outcomes.

9. Literature review • Nursing leaders are faced with four distinct generations of nurses which each offer their own set of values, work ethic, and communications style. As such, adaptation of the nursing leader to yoke together all of these attributes is necessary (Stanley, 2010). • Nurse managers should clearly identify both personal and organizational expectations across all levels of nurses (Hu, Herrick, & Hodgin, 2004).

10. Literature review cont. • Nurse managers should accommodate employee differences by learning about their specific needs such as flexible scheduling(Hu, Herrick, & Hodgin, 2004). • Address generational differences as a whole in order to nurture an environment of open and respected dialogue concerning expectations as well as what factors both attract and promote retention of these nurses(Hu, Herrick, & Hodgin, 2004).

11. Ausburger’s model of carefronting • Kupperschmidt (2006) describes using “carefronting” as a strategy for addressing conflict within the multigenerational workforce. Carefronting, as originally described by Augsburger in 1973, is a model of communication in which the party effectively cares enough to confront an offending party respectfully. The theory behind this approach is based on the fact that confrontation is a natural yet positive experience that integrates true forgiveness in order to move forward with both personal and organizational goals.

12. Kupperschmidt’s Adaptation of Carefronting to Nursing • Kupperschmidt (1994) adapted carefronting to a nursing approach. She describes carefronting in nursing as caring enough about oneself and personal goals to confront another in an affirming yet caring and responsible manner.  • She points out that carefronting is pure, honest communication, and considers a lack of this as a form of dishonest communication which impedes the attainment of both personal and organizational goals.

13. Implementation • In order to implement a plan for integrating Kupperschmidt’s adaptation of carefronting to nursing, specific steps should be taken. • Staff should be educated on the model as well as what the perceived goals of use are. It should be presented to staff in such a manner as to promote improved communication skills rather than just offering complaints. • Staff should be educated on the topic of multigenerational nursing and what a positive opportunity it is for their team to work together in order to improve their day to day lives as well as improve patient outcomes.

14. Implementation cont. • Education should be provided as to what the expected outcomes of using this approach are. Staff should be aware that the outcome of implementation of this model will be reviewed in order to evaluate quality improvement that can be applied to other areas. • They should also be aware that although the nursing manager or leader maintains the responsibility for facilitating this implementation, it is up to each nurse personally to understand the responsibility they have individually to communicate with each other respectfully.

15. Evaluation of Implementation • Evaluation of the application of the model could be done in many ways. • One method of evaluation would be to poll each nurse on a unit that is going to be implementing this model of care. Questions would be quantitatively scored based on a number that could then be reassessed post-application of the carefronting model. • Each nurse could be provided questions rating their satisfaction with communication between staffand nursing leaders. Further questions may seek out self-satisfaction with their current role and barriers to their communication.

16. Evaluation of Implementation cont. • At a specified time interval, these same questions could be readdressed with the hope that implementation of the carefronting model would have improved communication and therefore overall scores. • At that point the model could be reapplied as well as reinforced in order to promote the momentum of this opportunity for positive change.

17. References • Atwater, D. & Jones, A. (2004). Preparing for a future labor shortage: How to stay ahead of the curve. Graziadio Business Review, 7 (2). • Hu, J., Herrick, C., & Hodgin, K. (2004). Managing the multigenerational nursing team. Health Care Manager, 23(4), 334-340. • Kupperschmidt, B. (1994). Carefronting: caring enough to confront. The Oklahoma Nurse, 7 (10). • Kupperschmidt, B. (2006). Addressing multigenerational conflict: mutual respect and carefronting as strategy. Online Journal Of Issues In Nursing, 11(2),

18. References (cont.) • Stanley, D. (2010). Multigenerational workforce issues and their implications for leadership in nursing. Journal Of Nursing Management, 18(7), 846-852. doi:10.1111/j.1365-2834.2010.01158.x