As I approach the anniversary of my fifty-third trip around the sun I have been thinking a lot about how my work life has changed over the years.
I graduated from nursing school in 1988…thirty years ago! I had attended the University of Cincinnati College of Nursing and Health’s bachelor’s program. Such a program is heavy on course-work and a bit skimpy on clinical training (in my humble opinion). Of note, I will remind readers that attending college in the ’80’s meant you researched all your papers in an actual library with actual books – there was no internet, let alone “Google” for the assist. We took our state boards over two days, typically in the state capital city (for me, Columbus, Ohio), with number-two pencils and “scan-tron” sheets. It took about six weeks to learn your results. In the interim, you could accept a job, were limited slightly in what you could do legally, and signed your paper charts with a special identifier after your name that noted your status as a nurse, just not yet registered.
Back in those “old days,” new graduate nurses were conditioned to expect to work a year or two in a general “med-surg” unit before ever hoping to transfer to an intensive care environment. Nurse residencies were unheard of, and “orientations” were brief. Your more “seasoned” peers likely dumped on you, giving you rotten assignments and leaving you to fend for yourself a lot – a “sink or swim” indoctrination to your chosen profession. Definitely, some took you under their wing, but there were also those “Nurse Ratchets” who treated everyone gruffly. It was a common saying in those days that “nurses ate their young.”
I have had the benefit of working in a variety of hospitals and specialties, so have seen the various styles of nursing practiced by individuals as well as by “teams.” Some nurses played better with others, some not so much. You might be surprised to know that physical unit design often plays a huge role in getting your well-oiled machine running smoothly, or not. Once upon a time, private rooms were reserved for Very Important Patients, or those who were willing to pay more for that luxury. Depending on the facility and even the unit within a facility, you would see anywhere from two to six or more beds in a ward or “pod.” Privacy was limited to cloth curtains – you might not see your “roomie” but you generally heard everything that went on behind the veil. From a nursing perspective, I actually found the multiple-bed environment more desirable since all my patients were cohorted together – it was easy to see if someone was having a problem without relying on a third party to locate and notify you before you could respond. These days, however, private rooms are becoming the new “norm” and every hospital that can afford to have renovations done to accommodate that, will. (I do not know whether insurance makes any stipulations about rooms anymore. To my knowledge, you also do not get charged extra for a phone or television in your room.)
Teamwork effectiveness varies in those differing physical environments as well. With each patient having a private room these days, I see fewer nurses entering a room that they are not assigned to, to do something as simple as address a machine that is beeping. “Not my patient, not my problem?” Sometimes. Sometimes it’s simply that they recognize the beep for something innocuous so leave it for the nurse assigned to that patient to deal with whenever.
Another sad commentary on private rooms is that you don’t always know when your coworker is having a serious problem, whether it is an actual patient emergency or just that he/she is overwhelmed by his/her assignment and needs an extra pair of hands. In emergencies, it takes precious seconds – minutes, perhaps – for that nurse to call out and have help sent in. In the open bay/pod design, you merely had to look up from whatever you might be doing to notice that someone else needed help now! But, “customer service” is important and private rooms are what the customers want, so that is what they now get.
On the positive side, I will say that technology and medical advances have greatly improved the care that we give our patients. My primary focus is in neonatal intensive care. When I took my first NICU job in 1990, I was amazed at what we could do for infants as young as twenty-six weeks gestation. Of course, certain beliefs in what premature babies experienced meant that we didn’t always address their developmental needs adequately or appropriately. “Minor” surgical procedures were often done at the bedside with just a paralytic and no sedative or pain medication offered. We know much better now. Also, we are saving infants born as early as twenty-two weeks gestation. It is amazing! We manage infants from earlier ages without mechanical ventilation, saving many of them from future chronic lung disease. We know more about preventing intra-cranial hemorrhages and retinopathies. We are offering better quality of life to the tiniest of humans.
For all the wonderful advances made in medicine, can we say the same about nurses?
Those of us who embody either the baby-boomer or Gen-X generations have witnessed a perceived difference in the people coming into the profession over the last decade or so. While I have encountered some really tremendous young men and women who are very smart, quick to learn, and extremely dedicated to their calling, I have also met others who are, well, “less” than all that. Yes, sure, there have always been nurses who are not the caliber I would like to see in every generation. Perhaps I am only seeing what I want (or don’t want) to see in this latest generation. What I think cannot be denied is that the “millennial” nurses certainly have a different mentality in general from us “senior” nurses, and I am not reassured that it is all for the best.
Millennials have been judged, unfairly in many cases, of suffering from significant entitlement issues. Just since the early two-thousands (2002, 2003 or so), I have seen more new nurses come into the work place with expectations that we older nurses would never have contemplated in the very beginning of our careers. This latest generation has no concept of “low man on the totem pole” and “seniority.” I find too many young nurses insist that everything be “fair and equal”, not understanding that nothing in life is fair, nor equal.
More new graduate nurses are entering specialty fields right out of school before they have developed important organizational skills, let alone critical thinking skills. They simply do not know what they don’t know. As more and more senior staff retire, or cut back their hours, there are fewer and fewer experienced nurses to precept these new hires and teach them things they need to know now, as well as things they need to know later. More and more, new graduate nurses are being trained by nurses who have barely one year of experience themselves, mixed in with some shifts with an experienced nurse, if there is one available. Someone who became a specialty nurse right out of school doesn’t know enough to effectively teach another new grad the skills they will need in a crisis.
On top of that, millennials are being mentored into management positions of critical care units with very little clinical nursing time under their belts. While it’s true that managers do not have to be able to perform that actual work of the people they manage, it’s always better when they can. How do you evaluate someone’s performance if you are not familiar with what they are expected to be doing? Millennial managers like to toss out lots of catch words and phrases that sound meaningful but really aren’t, usually preceded by a pound sign – oops! a “hash-tag”, so that it “trends.” The word “team” especially is bandied about as if to include everyone, yet actual engagement of all age groups seems to be unimportant. On paper it is. In reality, it often feels as if older, experienced nurses are being “marginalized” (to use one of those trendy new words), and when they remove themselves further from participation – whether it is cutting hours, removing themselves from committees or groups, or just leaving altogether – it’s as if the younger crowd breathes a sigh of relief. Nothing is done to discern why the older nurses are growing unhappy, nothing offered to keep them and their expertise around.
Like everything else, the world is evolving and the new generation is molding it to suit them, as they should. I wonder what older nurses thought of me as the new kid on the block. Perhaps they thought I had ideas that were not going to do our profession proud.
Where I am now, I worry about the future. I worry that catering to a millennial’s need for acceptance more than ensuring their continued clinical education and growth by the most experienced nurses available will result in some pretty significant, negative, yet preventable events. We care about our patients. We care about these young nurses. Some of them truly appreciate what knowledge and support we offer.
But there are some who come to the profession with an attitude that screams “I got this!” without the skills to back that up. And when they get “schooled” by an older colleague, it is taken as harsh criticism and even “bullying.” The older nurse ends up being the one “scolded” while the younger one is given what she wants under the premise that everyone has a right to new experiences, even if they lack the skills to do the best job possible.
I’m not sure what types of seminars managers in the medical field attend, whether there are enough that are specific to medicine, or if they attend lots of generic management seminars that are geared more towards the corporate world. Hospitals are a 24/7/365 operation with very specific and unique employees and customers that cannot and should not be placed under the same management style as, say, a financial corporation. “Teamwork” in nursing involves much different interactions with your peers than a group putting together a portfolio to win over some wealthy individual client. In an office setting, one person may be able – and willing – do perform a variety of tasks to get a project completed. When a patient codes, I need to trust my team to know their roles and be able to perform them as no one person can run a code unassisted and expect a successful outcome.
The simplest answer is to provide new graduate nurses with the most experienced support available as they begin their career, pairing them with the nurses who will teach them the most in the time they have together. Worrying about making sure they develop friendships and ties to colleagues of similar age should not be a focus of management. Friendships will occur in time, as they should after you’ve ensured proper training has taken place. Placing the focus on the millennial’s satisfaction without ensuring your senior staff are also satisfied in their jobs simply exacerbates the problem of not having enough experienced nurses around to teach the next generation what they need to know.
Perhaps my work place situation is unique and other institutions. Perhaps other units within my own organization do not have similar concerns. Perhaps I am coming across as a “disgruntled employee”.
My hope is that more managers take a good look at their unit’s staff and really see how the various age groups interact, then, without bias, work to ensure everyone’s satisfaction. The result will be a new generation of nurses who are better trained to care for their patients, and retention of those who will continue to impart their wisdom on them.
