A survey released March 1 from the American Nurses Foundation and Joslin Insight showed Generation Z and millennial nurses — who belong to the generations born between 1981 and 2012 — have been hit hard by the pandemic, with many suffering from mental health issues and about 60 percent saying they will leave or are considering leaving their positions.
Becker's spoke with about a dozen nurses at systems across the country about what they feel is lacking in their current environments and what employers could do to fill those gaps.
Four common needs emerged from the conversations: work-life balance, better pay, more support and improved working conditions.
Nurse experiences
Lindsey Klinges, RN, 23, has worked as a registered nurse at Geisinger Wyoming Valley Medical Center in Wilkes-Barre, Pa., for two years. Before that, she worked as a nursing assistant in the hospital's progressive care unit.
As a May 2020 nursing school graduate, Ms. Klinges acknowledges she missed out on some experiences before becoming a bedside nurse, because of the COVID-19 pandemic. But she said she currently works with a good team of nurses.
"I think we work really good as a team. Regardless if we have new travelers or new nurses," Ms. Klinges said. "We really help out our neighbors and try to make the care as best we can for our patients."
One thing that perhaps separates her generation from older ones is tech savvy, Ms. Klinges said.
"When I was in the [intensive care unit] the other day, we looked at beds that are technology run," she explained. "Older nurses didn't know how to use them. We were going back and forth about what worked for us, what didn't work for us."
Overall, she said the beds are supposed to help prevent pressure ulcers and make it easier for nurses to transport patients between different areas of the hospital.
Rachel Cameron, RN, is a 29-year-old surgical intensive care unit nurse at Tufts Medical Center in Boston.
She described the current work environment as stressful.
"Right now, patients are sicker than ever, and that's something that has been trending more in the last 10, 20 years. Patients who decades ago would have been dying are now living in the ICU, and patients who are on the regular floors in the hospitals would have been ICU patients," Ms. Cameron said.
"So, there's a general uptrend of acuity in hospitals, compounded by the fact the population is aging, people are living longer with more comorbidities," she said.
Adding to the stressful work environment is a lack of adequate healthcare staffing because people are quitting amid what has been deemed the "Great Resignation," or people are getting burned out from the work, she said.
Generational differences may also come into play with nursing turnover. Previous generations of nurses were more likely to stay with one health system for the majority of their career, but Gen Z and millennial nurses are "being a little bit more savvy about their money" and have no issue jumping to a new employer that better suits their needs, according to a 25-year-old intensive care unit nurse at a large nonprofit health system in the Midwest who wished to remain anonymous.
"I come from a long line of nurses, and my mother, my grandmother, they are all career people that have stayed with one hospital group for the majority of their career," the nurse said. "Whereas a lot of nurses who have come up more recently are less likely to do that because they're essentially going to chase the benefits and work-life balance."
Outside of work, Ms. Cameron pointed to personal difficulties people are facing, especially those in her generation who have a lot of student loan debt and are receiving wages that have not been keeping up with the cost of living.
"When you're constantly stressed at work and also stressed at home because of financial difficulties, it's going to lead to earlier burnout among people in my generation," she said. "The key to that is you have to alleviate the personal stressors, i.e., increase wages, or you have to relieve the professional stressors, meaning more staffing, more ancillary staff to help."
Ms. Cameron encouraged hospital executives to listen to millennial and Gen Z nurses, and to try to get millennial nurses on hospital committees and in hospital leadership roles so they can have a voice at the table.
Ten things nurses need more of, in their own words:
Editor's note: Responses were lightly edited for length and clarity.
On-the-job training and support. "We are in the unique position of graduating in a global pandemic where we might not have gotten well-rounded experiences, hands-on learning, or in-depth training because of alternate or virtual learning," said Gabrielle Angeline, 25, BSN, RN, former cardiac nurse at Altamonte Springs, Fla.-based AdventHealth. "Hospitals are not prepared to train new grads on every aspect of nursing and make up for the deficits from nursing school. It is all unprecedented, but Gen Z nurses are the ones suffering in the workplace."
Ms. Angeline said she applied to around 350 jobs in Chicago when entering the field. "I got denial email after denial email because I did not have experience, but if I'm a new grad, where am I supposed to get experience?" Ms. Angeline said. "Nurses are in high demand. We have been in the middle of a nursing shortage for years, and not just because of the pandemic. I was told in nursing school that baby-boomer nurses made up around 1 million nurses in the field, and as retirement age draws near, those positions will all be available."
"We do not have the years of clinical judgment and experience that these nurses do, and healthcare organizations need to do more to prepare us to fill those roles and support us as we attempt to fill them," she continued.
Mental health support. "I have been thrown into a profession where I am expected to take care of three, four, or five humans for 13 hours a day with only six weeks of training to prepare for a thousand different situations we could face every shift," Ms. Angeline said. "Much of nursing is using nursing judgment, trusting your gut, and using evidence-based practice to care for your patients. Nursing judgment takes time to develop and often we rely on more experienced nurses as our sounding board. As these nurses retire, quit, or leave the bedside, Gen Z nurses are left to hope they have access to resources to help them get through a shift. That is not good for our patients, nor us."
Financial support. "My rent is $2,000 a month before bills. I am barely making enough money to pay for my rent, bills, student loans, and insurance," Ms. Angeline said. I have been told by many older nurses that organizations have cut hourly pay and differential severely since the pandemic when hiring new grads. Young nurses have to consider travel nursing in order to make ends meet or build up savings. The cost of everything is expensive right now, and cutting hourly pay is not going to help Gen Z nurses afford to live, contribute to the economy, or simply succeed."
AdventHealth emailed a statement to Becker's.
"Knowing that each generation is unique in their preferences for engaging in the workplace, AdventHealth offers team members access to a wide choice of benefits that support the whole person - body, mind and spirit," the statement read.
"AdventHealth offers team members mental health, wellness and financial support resources in addition to career growth and education assistance. Especially through the pandemic, AdventHealth has continuously listened to team members’ needs and is constantly enhancing its offerings accordingly to support its workforce. In listening to our millennial team members, we understand that their priorities involve a job that is more than a steady paycheck and instead a career that aligns with their purpose and offers competitive market pay. Rather than a 'boss,' millennials desire a 'coach,' and place a greater emphasis overall on work-life balance and professional development."
AdventHealth also noted initiatives it is implementing to support its workforce, including a "newly enhanced" career growth program for team members, which offers student loan support coaching, career path planning tools, debt-free education assistance and more.
Respect and recognition. "At the start of the pandemic, people all over the world were praising nurses. Now, we can't help but feel forgotten," said Jennifer Gil, MSN, RN, director-at-large of the American Nurses Association's board of directors. "Nurses need to feel valued, respected, and prioritized. More than anything, nurses want to feel safe and valued in order to best care for their patients."
Improved working conditions. "What do I need to feel safe, happy, and fulfilled? I need the working conditions for my profession to improve," Ms. Gil said. "A simple but complicated request for all stakeholders. Change must come in all forms. Employers need to get creative and transform outdated staffing models that no longer work. A true financial investment needs to be made in order to achieve this. Congress needs to look beyond nursing wage caps and in turn, look at innovative legislation that values nurses and involves them throughout the process. Funding for nursing education and training needs to be increased. The solutions are there. Nurses know what they need. We just need people to listen and act."
Long-term workforce solutions. "We are lacking long-term staffing and overall workforce solutions to help us mitigate the stresses the pandemic has brought to our health care system. This can be done by increasing the number of career ready registered nurses who work at the bedside," Amanda Buechel, BSN, RN, director-at-large, staff nurse on ANA's board of directors. "Additionally, we need increased recruitment and funding for nursing educators to be able to enrich students’ nursing school experience and to prepare students for their career."
Patience. "As a Gen Z nurse, I feel like there are a lot of things the workplace needs. One thing in particular that comes to mind is patience," said Shannon Atkinson, 24, a nurse at Missouri Baptist Medical Center in Town and Country. "I feel like as new/young nurses, we are expected to know a lot more than we actually do when we first start. But in reality, we are asking questions constantly. Oftentimes I feel like I'm a burden or a nuisance on the older, seasoned nurses or on patients and their families because there is still so much I don’t know and need to ask them about. Sometimes we are treated like we are dumb and incompetent because of things we don’t know, when honestly as a nurse, you should never stop asking questions."
"The notion of 'nurses eating their young,' or older, veteran nurses and other staff such as nurse practitioners and doctors being impatient, and sometimes downright rude, to[ward] new and orienting nurses needs to be abolished," said Florida-based nurse Bari Miller, 23. "The profession is not an easy one, but a friendly and supportive environment in which the healthcare team works together to provide the best patient care can truly make all the difference."
More flexible working hours. "Gen Z/Millenial nurses need more flexible working options," said Shantelle Cruz, a nurse at Broward Health North in Broward County, Fla. "We are looking to be able to choose our own schedules and which hospitals we work for. Having multiple options for how we want to work is so helpful. Being able to go the traditional route of taking on a full-time role at one hospital, or picking up shifts at multiple facilities to work around other commitments we might have, such as childcare or other responsibilities."
To be fulfilled. "I went into healthcare to take care of people. It just frustrates me when sometimes I go to work and it feels more like I'm at a business doing work, not that I'm here taking care of people on their worst days," said a 24-year-old trauma medical-surgical nurse at Advocate Christ Medical Center in Oak Lawn, Ill., who wished to remain anonymous.
The nurse said she especially felt this when the hospital placed an emphasis on discharge numbers amid the pandemic.
"There was just so much push all the time about having this percentage of people pushed out the door by this time," she said. "We don't want anyone sitting in the hospital longer than they have to, but it was just so frustrating because sometimes it felt like they cared more about the numbers that made them look good, not so much how busy we were and how ridiculously crazy some of the things they needed us to do were."
The nurse said she'd prefer leaders to have "a little more focus on, 'Hey, how can we help you?' Not, 'Hey, you need to get this many people out the door.'"
Advocate Aurora Health Chief Nursing Officer Mary Beth Kingston, PhD, RN, shared the following statement with Becker's: "We're proud of our dedicated nurses, who use their clinical expertise to lead the way and provide exceptional care amid a nationwide staffing challenge. We remain committed to providing a comprehensive well-being program, robust resources and bold and creative recruitment and retention strategies to support our nurses."
Continuing education support. "I want them to make good on their processes to help me with my continuing education," said the 25-year-old intensive care unit nurse who wished to remain anonymous. "We have more than enough organizational support from the hospital group. They will give you proportional money towards your professional development and straight out-of-pocket cash depending on how much you do. But the main focus of being employed there right now is just to have bodies on the floor … Of course they want you to do better, but they ultimately need the labor. That has pushed a lot of our Gen Z and millennials out of this hospital so that they can take contracts to pay off school out-of-pocket rather than taking a contract obligation for tuition reimbursement through the hospital."