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Leading Generations


HCA Study Sheds Light on Millennial & Gen Z Nurses

A recent study by HCA Healthcare is shedding light on generational changes facing employers. Released last month, the study of millennial and Gen Z nurses cites open communication and professional development as key incentives for tomorrow's healthcare leaders.

An Evolving Workforce

Jane D. Englebright, PhD

"This study came out of trying to understand changes in our workforce," said Jane D. Englebright, PhD, RN, CENP, FAAN, senior vice president and chief nurse executive for HCA Healthcare. "HCA Healthcare is a 50-plus-year-old company, and we've always valued loyalty and longevity; but we started noticing different expectations from newer employees. We wanted to take a hard look and make sure we're as welcoming to new employees as we are to long-term employees."

Commissioned from the Center for Generational Kinetics in 2019, the study of 1,250 participants confirmed the importance of career development to millennials - and not in the traditional sense. "We realized that what it means to them is movement, to be constantly learning something new and gaining new experiences as opposed to climbing a traditional leadership ladder," Englebright explained.

Those findings and other insights are advantageous for the health system, which employs 98,000 nurses nationwide. "We bring on new nurses every day, so understanding the people we're hiring is so important for us to be able to respond to their needs. We're unique because we have so many hospitals, so we can offer employees any site or specialty area of interest."

More locations also mean more opportunities for internal recruitment and lateral movement. And while Gen Z and millennials often catch flack for having high expectations of employers, Englebright said younger nurses have equally high expectations of themselves. "We found that to be really affirming and positive," she said.

Major Influences

The study identified several major influences on millennial and Gen Z nurses when evaluating current or future employment options, including the importance of team and managerial relationships, communications, ability to share ideas, opportunities for advancement, and access to the latest tools and resources for career development. Among the most important factors in creating a positive work environment were nurses' relationships, communication and ability to grow professionally:

  • Nearly half (44 percent) of millennial and Gen Z nurses rated team and managerial relationships as the top dynamics in a positive work environment;
  • 42 percent of nurses cited communication and the ability to make clinical decisions as important factors;
  • 43 percent said the opportunity to grow professionally through career advancement was a crucial factor impacting the work environment; and
  • More than a quarter (28 percent) of nurses also cited the importance of modern facilities and updated equipment as a factor in a positive work environment.

Support System

Additionally, the study looked at what helps nurses feel supported at work, as well as how nurses view career advancement and the need for training. More than half (57 percent) feel most supported through their team and co-worker relationships. Drilling down, support characteristics - such as scheduling flexibility, staffing levels, personal relationships, teamwork, training and the ability to have a voice in the organization - were consistently rated as important or very important by 43-46 percent of the nurses surveyed.

  • Flexible work schedules was selected by 49 percent as the top way to help nurses feel supported, while 47 percent said having a clear pathway to sharing your ideas or having your concerns heard helps them feel supported.
  • For millennial and Gen Z nurses, career advancement may not always be represented by vertical movement. Over a quarter (28 percent) of nurses rate being given increasing amounts of responsibility equal to moving to a different floor or department.
  • Still, having a clear direction or knowing exactly what is needed to advance your career was rated as important or very important by 46 percent of nurses, and 36 percent of nurses chose career advancement training as the most helpful type of employer education.

"One of the more surprising findings was how important relationships are," Englebright said. "We tend to think of this generation as tech-savvy individuals who would rather text than talk to you, but this showed us they really are about person-to-person connections in the career advancement space."

Educating Leaders

HCA Healthcare also is working to bridge generations through conversations with nurse leaders. Englebright said helping older, experienced leaders understand differences is demystifying stereotypes and helping them understand the faster pace - and leadership potential - of younger generations. Her hope is to see nursing retention rates continue to improve, as the system becomes more sensitive to needs and expectations of younger nurses. She also hopes to develop more formal mentoring programs and more effective methods of tracking lateral movement to encourage career mobility.

"We've been very conscious of doing a better job of orienting new nurses through our residency program, cross training, highlighting lateral career movement, and doing a better job of saying, 'If you're a nurse in med-surg and want to become a burn nurse, here's the progression," Englebright said of putting the study insights to work.


HCA Healthcare

HCA/Center for Generational Kinetics National Nursing Study


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Gen Z, HCA Healthcare, Jane Englebright, Millennials, Nurse Leaders, Nurses
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