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The Next Generation of Leaders

February 3, 2017


The Next Generation of Leaders

Guiding Millennials in the Nurse Workforce

Millennials now surpass Generation Xers and Baby Boomers as the largest segment of the American labor force, according to a 2015 U.S. Bureau of Labor Statistics report. Born approximately between the early 1980s and the early 2000s, Millennials now represent 34 percent of the general workforce—and it is projected that by 2030 they will represent 75 percent.Millennials now surpass Generation Xers and Baby Boomers as the largest segment of the American labor force, according to a 2015 U.S. Bureau of Labor Statistics report. Born approximately between the early 1980s and the early 2000s, Millennials now represent 34 percent of the general workforce—and it is projected that by 2030 they will represent 75 percent.

The numbers are quite different for the nurse workforce right now, however. The American Nurses Association noted that of the 3.1 million people working as nurses, only about 18 percent are Millennials. The mean age for nurses is 50, and over half of these Baby Boomers over 50 are still working. Even though many Boomers have delayed their retirements, at some point soon the workforce will register the loss of these experienced workers. The Bureau of Labor Statistics has projected a 19 percent growth in employment of registered nurses through 2022. The result is likely to be shortages in the field from the massive retirements of these experienced nurses, and keen competition for qualified applicants.

Millennials will be the ones filling these positions, bringing with them their unique generational style and outlook. The bright side for the healthcare industry is that a healthy percentage of this generation feel positive about future employment in healthcare. A new survey from the National Society of High School Scholars reported that out of 200 companies ranked by students, healthcare companies took 7 out of the top 25 slots. Some notable hospitals such as St. Jude’s Children’s Research Hospital ranked high on the list—but the 6th-most preferred employer was a “local hospital.”

What does this influx of Millennials mean for the hospital and surgery center workplace? How will they transform employee and peer relationships and management practices and procedures when they are the leaders?

Who are the Millennials?

Kate Christmas, RN, from the Bernard Hodes Group, described the characteristics of Millennials in a 2008 report as:

• Growing up with an extreme affinity for and comfort with technology
• Tremendous, positive attention and influence from parents and teachers
• Structured, supervised childhoods with very little unscheduled time
• Unusual respect for authority and acceptance of “the rules”
• Belief in the collective power and positive influence of their group

In addition, they are multitaskers who are adept at communicating and remaining connected with friends and families. They are used to working in teams and value collaboration, and they tend to have a global and inclusive perspective.

Britta DeVolder, MBA, BSN, RN, CNOR, AORN, Executive Director of Perioperative Services at University Hospital in San Antonio, Texas, is a Millennial herself. She acknowledges the typical nature of Millennials, but for her it’s a bit more nuanced: “There’s a divide between the Millennials. There are those Millennials who have always gotten participation trophies and expect a certain level of appreciation,” she says. “And there’s the other side of it, where we realize that we still need to work for it, and that there is going to be tough love.”

What’s Difference About This Generation?

Lynn Crowley, MHA, BSN, RN, CNOR, Texas Regional Director of Perioperative Services for Tenet Healthcare, notes that if Millennial nurses don’t feel that they are valued, there are real consequences. “Disengagement and frequent turnover occur if the more seasoned staff and leaders dismiss their ideas. Once they become experienced perioperative staff, they are often lured away by the promise of a position that better fits their personal needs where call and weekend work is nonexistent,” she said.

This kind of “experience harvesting” is a strong characteristic of this generation. Britta DeVolder noted that Millennials “have no loyalty to any institution, whereas in previous generations there’s extreme loyalty. . . . You can experience so much more by going to different places and grabbing experience from one institution and bringing it to another. It’s knowledge sharing. That’s something that millennials are really good about, taking experiences and building on them. I don’t think it’s recognized a lot.”

Britta DeVolder acknowledges this attitude in her Millennial staff members, and it underscores her management style. “Put them to work when you have them. Value them for when they’re with you. Then don’t get too upset when they decide, okay, bye, I’m gone. Because there’s going to be somebody else to grow behind them. You have to respect that mobility in our environment.”

Millennials’ comfort with technology sets them apart in many ways from older nurses, but gives them a distinct advantage in the healthcare environment, where changes in technology come fast and furious. “We can no longer ignore the benefits of technology and leverage it in our daily work,” says Lynn Crowley. “Those nurses that have grown up around technology definitely adapt more. As an example, they are very comfortable around laparoscopic cameras, monitors, and robotics, often becoming super-users.”

What’s Important in Working with Millennials?

The communication style of this group also varies widely from previous generations. “Millennials like quick communication, since they’ve grown up with email and text messaging. They’re likely to grow frustrated when they have to wait for a response. And they’re not really into reading lengthy communication documents, like long instructive emails or PDFs,” writes Sarah Leavitt in Nursing Community Journal. “Make allowances for the different styles,” she writes. “Consider using texting and micro-content, like short quizzes or videos, as part of your learning or development strategy.”

Millennials also want to see their leaders as mentors, and coaches, not as authority figures. “They have become accustomed to structure, guidance, and intervention from their parents and teachers, and they expect the same in their careers. In nursing, it should be demanded, as there are few other professions with as much responsibility,” writes Kate Christmas. The chance to create solid mentor relationships must not be overlooked.

A deep sense of worth underlies this young generation. It’s crucial to them that their work is meaningful, and many of them go into nursing because they want to make the world a better place and make a difference in their patients’ lives. Clearly communicating the mission and values of your workplace has become increasingly important.

This sense of meaning extends to Millennials’ insistence on a healthy work-life balance. Lynn Crowley notes that “Working 12-hour days five days a week, as many OR Directors (including myself) succumb to doing, can lead to burnout. We have had to adapt our staffing strategies to account for Millennials’ approach to work. Flexible shifts, creative on-call strategies, and matching staffing to demand are critical to staff retention.”

Strategies for Management

The strong fellowship program at University Hospital in San Antonio, where Britta DeVolder works, is a great model. “We bring in new grad nurses and train them to be operating room nurses and operating room techs. We pair them up on purpose with our more experienced and tenured staff, knowing that they could be retiring in the next couple of years, or with people who have an awesome wealth of knowledge that they’re good about sharing, or are good at teaching,” she says. “We try to grow more people to understand where that knowledge comes and why it’s there. We give our new staff the tools to question that knowledge and say, ‘I learned in the textbook that this is what I’m supposed to be doing. So why do you do it this way?’ So there is some longevity to the knowledge, and we don’t lose all of that every six months when somebody leaves.”

Dennis Glover, BSN, MSN, MBA, former Director of Surgical Services at Baptist Beaches Hospital in Jacksonville, Florida, has worked hard to combat misunderstandings that arise from generational communication differences. “One of the things that we’ve done is to set up some time to meet, and we pose a problem. We ask, how would you go about solving it? We go around the room and get some advice from more experienced people about how they’d go through these steps of solving it. Then we bring in the new people and say, you may not agree with this. Why don’t you? Let’s talk about this and let’s get some sounding boards back between us all. We bring the emphasis more on the communication standpoint than on whether there are right answers to the problem set,” he said.

“Getting your staff to understand the differences is important,” Glover continued. “We try to decrease that communication gap or open it up so that your older folks understand how the newer folks communicate, and vice versa. Because it’s hard. If you can’t get that, then you’re going to have staff problems. If you can get to where your staff is starting to move together, and understanding the differences, then the teaching and the mentoring and the camaraderie will get there.”

Karen Benedict, RN, BSN, MSN, former Director of Perioperative Services at Sarasota Memorial Hospital, succeeded with another good strategy. “I have assigned experienced nurses to new nurses to orient them and support them. This person is a safe space to bounce ideas off, to have lunch with, to learn how to cope in certain situations. This creates bonds that further assist with acceptance and understanding.”

Other strategies that work well with Millennials include implementing group work, using technology effectively, giving regular feedback, and providing flexibility, according to Tricia Hussung, who writes about managing Millennials in the workplace.

“Nurse managers must learn to be flexible,” writes Lisa C. Waters, BSN, MSN, Administrator and Director of Nursing Surgical Services at Vivere Dallas Surgery Center. “New approaches, new ideas, incorporating more social media, and offering different types of work schedules and benefits are just a few ways nurse managers can approach the challenges the new generation presents.”

Looking at the bigger picture, many believe that nursing education must improve to provide stronger clinical experience. Lynn Crowley says, “Unfortunately, nursing students today do not have much of an opportunity to get experience in any of the perioperative areas. As a perioperative leader, it is important to partner with your local nursing schools to help them understand the value of perioperative preceptorships and encourage them to develop senior electives in specialty areas that will better prepare students for employment in the operating room.”

Guiding Future Leaders

When the members of the different generations on your staff come to understand and respect one another, and a succession plan is in place, this will pave the way for the success of Millennial nurse leaders. “The Millennials are going to be strong if they’re given the opportunity.  They need reassurance that they’re going down the right path,” says Britta DeVolder. “But once you get past that hurdle of giving them that feedback, they really pull through and show their worth.”

Dennis Glover adds, “Millennials will invoke change.We’re going to see some dynamic looks at how we operate within the operating room and all our areas, as we question whether what we do now is the best way to do things moving forward. These insights and the other extraordinary qualities Millennials bring to the profession will forge a positive future for nursing and nurse management.”


Kate Christmas, RN. “Attracting and Retaining Millennial Nurses,” Bernard Hodes Group, 2008.

American Nurses Association. “Nursing by the Numbers” fact sheet, May 2011.

Susan Adams, “The 25 Companies Where Top Millennials Most Want to Work In 2015,” June 2015.

Sarah Leavitt. “The Future of Nursing is in Their Hands: Managing Millennial Nurses,” Nursing Community Journal, July 2015.

Eric Darienzo. “How to Attract and Retain Millennial Nurses,” “Engaging millennials: Leaders work on retaining younger generation of nurses,” August 2015.

Tricia Hussung. “Effective Techniques for Managing Millennials in the Workplace,” King University Online, June 2016.