Sunday, October 18, 2009

Recruitment, retention, and management of Generation X: A focus on nursing professionals

Recruitment, retention, and management of Generation X: A focus on nursing professionals

By Cordeniz, Judy A
Publication: Journal of Healthcare Management
Date: Monday, July 1 2002



Two-thirds of the nurse workforce are now over the age of 40, and between 40 percent and 60 percent of these nurses

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are expected to retire within the next 15 years. Enrollment in programs at all nursing education levels is declining. Generation Xers, those born between 1963 and 1977, comprise between 10 percent and 15 percent of the current nursing workforce. Although relatively new to the workforce, Generation Xers have their own ideas of what constitutes an acceptable workplace, and usually the terms of their employment are not negotiable. Further complexity arises from the fact that management of this workforce falls primarily on Baby Boomers-those born between 1943 and 1960. Because of the events that molded their collective characteristics, Baby Boomers entered the workforce driven and dedicated. This group equates work with self-worth, contribution, and personal fulfillment. Many selected their profession not based on economic prospects but with the desire to make the world a better place. In addition, their competitive nature drives them to aspire for higher monetary compensation and titles.

The challenge for healthcare leadership is understanding and creating harmony between these two generations. This article presents a summary of recent literature and studies that explain the basic distinctions in cultural characteristics and work ethics between Generation Xers and Baby Boomers. The summary, I hope, provides a guideline for recruiting, retaining, and managing Generation X workers in the nursing field.

Because the literature is not consistent, the first thing that needs to be clarified is the date range that defines Generation X. Date ranges found in the literature include:


1961-1981 (Tulgan 1997; Kupperschmidt 1998)

1965-1975 (Santos and Cox 2000; Hays 1999)

1965-1976 (Adams 1999; Woodward 2000)

1963-1977 (Rosner 1999)

1965-1980 (Jochim 1997; Karp, Sirias, and Arnold 1999; Poindexter 1999)

1987-1984 (Manolis, Levin, ana Dahlstrom 1997)

1965-1981 (Smith 2000)

1963-1982 (Kennedy 2000)

1965-1977 ( 1999)

1963-1977 (Tulgan 2000; Weston 2001)

Based on the literature, 1963 appears to be the most popular starting date, and 1977 is the most frequently used ending date. This date range coincides with the writings of Bruce Tulgan, who appears to be the initial investigator and predominate authority on Generation Xers in the workforce. For our purposes, 1963-1977 will be used as the range of birth years that identify Generation X. The literature is consistent in its description of Generation X by contrasting it with the Baby Boom generation, which approximately begins in 1943 and ends in 1960.

Following is a summary of the events and conditions that contribute to the mindset of the Baby Boom and the Generation X groups.


The Baby Boom generation began just after World War II ended. Baby Boomers were raised in prosperous, optimistic times and, for the most part, were doted on as children. They tend to think of themselves as the "stars of the show." Baby Boomers typically were raised in a nuclear family in which the "father-knows-best" model was followed. If the family life differed from this ideal, it was not made public. When many Baby Boomers were children, they witnessed man travel to the moon, John F Kennedy as president, and television sets invade living rooms. Life was comfortable and had a great purpose.

Baby Boomers entered adolescence with fits of idealism, rebelling and questioning the status quo. Older Baby Boomers were teenagers during the hippie culture of the 1960s. Groups set out to change the world through love, music, and nonviolent demonstrations. Civil rights protests and antiwar marches were commonplace. Current beliefs about the status of women are related to the many changes brought on by this generation. Younger Baby Boomers had a different teenage experience. The prosperity of the 1950s and 1960s tumbled with the oil embargo and the dramatic discoveries of the Watergate scandal. As a result, both older and younger Baby Boomers learned not to respect authority. Instead, they learned to challenge authority and question the integrity of leaders. They still tend to believe that no one in charge is to be trusted. Their heroes, unlike those of previous generations, were not war heroes, political leaders, or large businessmen. Their leaders were more likely those who opposed the status quo and rebelled against authority (Wiley 2000).

The tremendous size of the Baby Boom generation spawned alterations in the American culture and economy. When they were children, they made up 40 percent of the population. As a result, school systems were routinely overloaded. Competition was fierce in academics and sports because of the sheer volume of candidates. The special demands of raising millions of children and teenagers transformed the market for consumer goods, and the cost of raising Baby Boomers soared (Hays 1999).

As they entered the workforce, they were driven and dedicated. Having grown up with a sense that they were special and capable of changing the world, they equate work with selfworth, contribution, and personal fulfillment. Many selected their profession not based on economic prospects but with the desire to make the world a better place. In addition, their competitive nature drove them to aspire for higher monetary compensation and titles.

The introduction of the birth control pill, legalization of abortion, and liberalization of divorce laws ushered in smaller families; nontraditional family constellations of single parents and stepparents; dual-career families; and the phenomenon coined "latchkey kids" (Kupperschmidt 1998). The fear of a population explosion seemed to further erode the status of children among Baby Boomer parents, fostering a societywide hostility toward children. This cultural mindset resulted in many couples electing not to have children and parents spending less time with their children and adopting more permissive parenting styles.

Because of the different patterns they have followed for having children, Baby Boomers vary from having young children to having successfully sent their children to college. Many are parenting teenagers while dealing with aging parents. More than any other generation, they are dealing with a time squeeze. Demands of work, expectations of parenting, goals for healthy living, and a strong sense of idealism have kept most Baby Boomers running from morning until night. They have maintained a grueling work pace, but many have set goals to simplify their life. They have adapted to technology, motivated by the desire to be more productive and to have more free time.


Generation X had a dramatically different childhood than the previous two generations. Most grew up in a home where both parents worked; this distance from their parents was further exacerbated by high divorce rates. As a result, 40 percent of Generation Xers were in single-parent households in their youth (Wiley 2000). As the first latchkey generation, they came home from school to empty houses, cooked themselves a snack in the microwave, and entertained themselves with video games. As teenagers, they formed strong bonds with friends, turning to schoolmates when family was not available. Because of the diversity of their conjured "immediate" family, Generation Xers are more tolerant of alternative lifestyles. They are accustomed to great diversity in family situations, relationships, sexual orientation, ethnicity, gender roles, religion, and political affiliation. In addition, their school activities focused less on individual performance and more on team-based learning.

This generation grew up in the information age and is innately comfor-table with technology. Automatic teller machines, personal computers, push-button phones, and digital clocks are standard equipment for them. Their continuous use of technology has promoted Generation Xers to expect instant response and satisfaction (Hays 1999). They were educated during a period of experimentation, as "new math," open classrooms, and curriculum specialists entered the picture. There was a rash of public concern about the decreased academic quality of Generation X's educational experiences. These experiences, based on the theory of learning known as "educational humanism," emphasized the effective development of the student rather than the ability to read and write (Kupperschmidt 1998). They were the first generation to be demographically fewer than their predecessors (Corbo 1997). These factors contributed to this generation's decreased need to compete for survival's sake.

Politically, Generation Xers were born during a period of steady decline in American global power, kicked off by the Vietnam War and punctuated by the Iranian hostage crisis (Tulgan 1997). The economic prosperity of the United States was usurped by the dominance of Japan in the world market. Even the technological prowess of this country was called into question when the Challenger space shuttle exploded, an event seen by Generation Xers on TV screens in their classrooms. Exposure to violence and adult themes on television often forced Generation X teenagers to deal with adult subjects before they were ready. Holtz (1995) refers to the 1970s as "the period of the youthification of poverty," brought on by family dissolution, disappearance of fathers, and government policy.

Generation X children achieved the distinction of being the most impoverished generation in America. The old and the young competed for limited social-welfare dollars as federal funding of programs for the elderly increased. Funding of programs for families and children decreased, and the tax law reform added to the economic burden of families (Gross and Scott 1990). Generation X witnessed a record number of bankruptcies, Wall Street scandals, and massive corporate layoffs with the loss of high-wage jobs and benefits. They watched their parents struggle with rightsizing, downsizing, and layoffs after years of dedication to the corporate mission.


A good deal of the literature includes graphics of the generational differences between Baby Boomers and Generation Xers in terms of workplace characteristics, lifestyle characteristics, social values, motivators, de-motivators, communication styles, traits, workplace ideals, and stress strain and coping scales. This article focuses on communicating with Generation Xers in recruitment (attracting them), retention (keeping them), and management (the purest art form of communication). See Table 1 for a breakdown of the difference in communication styles.

Because of the unique behavioral traits of the different generations, recognizing what motivates each group is imperative. If the same nursing management methods are used for all individuals-regardless of generation-- unhappy nursing units will result. A number of the literature dealt with various means of collecting data on Generation X-what motivates them, what stresses them, and how do they view their own values. Focus groups tended to be the general method of data collection; however, some studies utilized questionnaire-type survey tools.


Table 1

One set of statistics that depicts the age generation distribution in nursing in general is the breakdown of the membership of the Association of Operating Room Nurses (AORN). These numbers were ascertained from a study conducted in an effort to isolate the work ethics and skills brought to the workforce by the Generation X nurse (see Table 2). This same study revealed the information in Table 3 when comparing the two generations of nurses (Hays 1999).

Generation Xers who responded to a Time-CNN poll described themselves as worried about and expecting tough economic times and expressed difficulty in climbing the corporate ladder. They voiced decreased expectations for, and their intent not to invest in, long-term corporate relationships and expressed a higher threshold for unhappiness than previous workers. Respondents admitted to their tendency to change jobs or start their own business if they are dissatisfied with the work and work environment. They claimed to be motivated by work that aligns with their values and demands and includes performance appraisals; reviews quantifying their achievements; outcome-- focused, short-term projects; and pay for performance (Barna 1992). The investigative work of Kupperschmidt (1998) lists the following as the most common characteristics of Generation Xers:


Table 2

Table 3


Independent, industrious, and resourceful

Value fun and balance in life

Slow to commit long term to relationships:

Extended adolescence-they remain in parents' homes and resist assuming adult roles

Boomerang-they leave and return to parents' home for economic reasons

They marry late to avoid commitment or divorce

Pluralistic and comfortable with diverse cultures and lifestyles

Materialistic-practical, seasoned consumers

Creative, decisive problem solvers

Flexible, adaptable, and comfortable with change

Voracious learners

Innovative risk takers and entrepreneurs

Value quantity and quality time with significant adults

Lack basic skills in reading, mathematics, and communication

Have a cynical, pessimistic, practical, reality-driven worldview

Have unrealistic expectations for quick solutions to adult problems

In a study where approximately 250 telephone interviews were conducted (Tulgan 1997), Generation X respondents described themselves as hard workers who view jobs and work as a means to an end and claimed to have little confidence in and loyalty to leaders and institutions. They said that college attendance is an essential job preparation and a competitive necessity. In descending order, they ranked the following elements of life as important: family, health, time, friends, religion, living comfortably, career, and money.

Bradford and Raines (1992) found in their interview with Generation X cohorts that the respondents demand and expect more, including having input into high-level decisions, from their organizations and managers than any previous generation. The researchers praised Generation X's comfort level with and knowledge of pluralism and multiethnic work places. Bradford and Raines described them as rebellious and irreverent workers who change jobs frequently-an average of once every 3 1/2 years; however, they argued that with appropriate leadership, Generation Xers are energetic, innovative employees. According to their findings, managers should spend time with them, asking what they do and do not want in their jobs. Managers should not expect Generation Xers to change their values but should learn to see their values positively.

Tulgan (2000) states that organization leaders have two choices: (1) focus more directly on the particular management needs of Generation X or (2) pay the price of losing the talents and innovations of a whole generation. He believes surveys reflect negative portrayals of Generation X because they were conducted by Baby Boomers with jaded expectations. Using a purposive sampling technique, Tulgan interviewed 85 cohorts that are diverse in gender, ethnic heritage, geographic location, and job experience. He posed the following two questions to each subject: (1) How are you being managed? and (2) How is that management style affecting your work? Respondents repeatedly articulated that they do not want to be managed by nor are they motivated by the use of fear, longterm rewards, managers who waste their time, and micromanagement techniques. According to Tulgan's research, Generation Xers want leaders who: (1) invest in their employees, (2) are willing and able to provide effective feedback, (3) understand work issues and respond to their needs and concerns, and (4) possess and exercise power to access the necessary information and resources.

Tulgan summarizes negative perceptions of Generation X as faulty interpretations and his findings as fact. He argues that Generation Xers are not disloyal, uncommitted, and cynical (faulty interpretation); instead, they are eager to contribute but cautious because their collective life experiences have taught them to expect little from life, adults, and institutional relationships (fact). Tulgan contends Generation Xers do not have a short attention span (faulty interpretation); rather, they want many answers to many questions from many sources. They are voracious learners, and their learning and communication skills are shaped by the information revolution (fact). Generation Xers are not intense and arrogant (faulty interpretation) but are powerfully independent, resourceful, and comfortable with new technology (fact). The charge that Generation Xers are greedy for rewards and eschew dues paying (faulty interpretation) is countered with the fact that they did not experience the fabled old-employment contract and promised job security. Instead, they are cautious investors who insist on a new employment bargain-a bargain that demands for managers who foster entrepreneurial abilities and provide opportunities for self-building and for assuming personal responsibility for work outcomes. The new employment bargain is an if-then premise-that is, if leaders will, then Generation X employees will (fact) (Hays 1999). Kupperschmidt (1998) further poses the following questions: Are Generation X employees-empowered, self-directed, flexible, creative, innovative, risk takers, problem solvers-what nursing has been talking about and longing for? Do nurse administrators understand the dynamics of and challenges posed by Generation X employees? Will nursing leaders adopt leadership strategies aligned with Generation X's work values and demands?

Santos and Cox (2000) explored the factors influencing occupational adjustment related to workplace stress among 413 nurses. Baby Boomers and Generation Xers reported quite different issues and perceptions of occupational stress. The researchers utilized a questionnaire and follow-up focus groups to collect their findings. A comprehensive instrument measuring three components of occupational adjustment (stress, strain, and coping) was given to registered nurses at staff meetings. Sixty-eight (68) percent of the RN population completed the instrument (n=413). Ten focus groups were held to clarify these findings associated with problematic scales (n=44). Of the 413 nurses, 1 percent were of the Mature generation, 43 percent were Baby Boomers, and 41 percent were Generation Xers. Respondents had the following educational attainment: 20 percent had associate degrees, 13 percent held nursing diplomas, 56 percent had a B.S.N., and 4 percent earned a M.S.N. Results revealed significant differences in perceptions of occupations stress between the Baby Boomers and Generation Xers.

Baby Boomers had significantly higher mean scores on stress scales of role overload-when resources exceed demand and role boundary, conflicting demands and loyalties. Two other significant differences were seen on role insufficiency: (1) training and skills exceed job demands, for which Baby Boomers had the highest mean scores, and (2) physical environment, where the workplace itself provides extreme conditions, for which Generation Xers had the highest mean scores. The focus groups further enhanced the following three generational themes: (1) orientation toward work, (2) length of service, and (3) workplace behavior. Baby Boomers, the largest group in this setting and the largest group working in all industries today, were angry at what they interpreted as lack of commitment and slacker attitudes of the Generation Xers. In addition, they considered the Generation Xers arrogant and self-absorbed. Baby Boomers were also tired of the revolving-door orientation of the Generation Xers. The negative perceptions were understood, but the intensity of these perceptions was compelling.

In contrast, Generation Xers did not convey negative perceptions of Baby Boomers with whom they worked. They also voiced great commitment to the profession and organization, but some clearly indicated they anticipated movement out of the institution one day and a few indicated they would move from the profession entirely during the course of their work life

to provide themselves with a more diversified skill set. They indicated that the arrogant attitude was not arrogance at all but their need to be self-reliant, as they have had to be throughout their lifetime (Smith 2000).

The work of Manolis, Levin, and Dahlstrom (1997) was intended to develop a scale measuring attitudes associated with the generation born between 1965 and 1980. The purpose was to gain insight into attitudes associated with Generation X. The investigation identified several reoccurring sentiments that provided a preliminary assessment of the extent to which individuals from Generation X concur. In addition, the study contrasted the attitudes expressed by members of Generation X with those expressed by Baby Boomers. The scale development method of the study was abstracted from sentiments derived from the 1991 novel Generation X by Douglas Coupland. The objective was to characterize these sentiments and to contrast the sentiments with those expressed by older people. The initial scale, consisting of 125 items, was categorized into seven dimensions: (1) parental units, (2) shopping, (3) McJobs, (4) yuppies, (5) time passages, (6) platonic shadows, and (7) worldview. A sevenpoint Likert-type scale (anchored by ,strongly agree' and 'strongly disagree') was developed based on the categorical sentiments and tested for construct by senior doctoral candidates in consumer behavior. The test pared down the items to 102 and the dimensions to six, eliminating worldview. Subjects consisted of 445 shoppers from a mall in southeastern U.S. The resulting sample consisted of 187 persons born between 1946 and 1962 and 258 persons born between 1964 and 1980. Although the study validated the Generation X scale (GXS) as a common measure of affect across numerous generations of persons, the test confirmed that differences do exist between members of Generation X and other generations based on the developed psychometric scale.

In a study conducted by Poindexter (1999), a large number of people were unfamiliar with the term Generation X, although newspapers and other mass media had increasingly been using the term. In her quest to evaluate the depth of the stereotypical term "Generation X" a random sample of 489 adults 18 years or older in the Austin, Texas, area were surveyed by telephone. Phone numbers were randomly selected from the area phone book and then 1 was added to the last digit of each number selected and that number was called. This method, called plus-- one sampling, gives those in different prefix areas a chance of being selected. This sampling method assumes that unlisted number are evenly mixed among listed numbers. Although that may not always be the case, it is a worthy tradeoff if one does not have the resources to fund a true randomdigit dialing sample (Lavrakas 1993). The survey, which took an average of 20 minutes to complete, focused on knowledge, opinions, and behaviors about the mass media's portrayal of Generation X. Three questions were used to measure familiarity with and meaning of the label Generation X:

(1) How familiar are you with the term Generation X? (Answer: Very, Somewhat, Not Familiar); (2) When you hear or see the term Generation X, what word or words come to mind? (Answer: Open ended); and (3) In general, would you evaluate the term Generation X as: (Answer: Positive, Neutral, Negative. Refusal to answer and "don't know" were also categorized).

Almost one in three adults said they were unfamiliar with the term, and 40 percent of those who were familiar with the term said it was negative. That negative evaluation increased to 45 percent for those under 30 (Poindexter 1999). The study revealed that if the newspaper industry and mass media are concerned about alienating current and potential readers (or for our purposes, employees), they (we) should use the Generation X label with caution when describing the 45 million young adults in this cohort.

As a marketing strategy, youth-oriented material on movies, music, and technology packaged with dazzling color, flashy graphics, and with the terms "Generation X," "GenXers" and "Xers" can be very self-defeating.


Recruiting Generation Xers

Billingsley (2000) cites three general themes that explain the work ethic and mindset of the Generation X workforce:

1 .Their loyalty belongs to themselves. They have no aspirations for gold watches or a silver tray after 40 years. They will stay in a position as long as it is good for them. They see themselves as independent contractors or free agents. Guilt tripping will never work with them.

2. They demand training. They want to learn everything. In fact, they want to know everything already, but because that is not possible, they will settle for intensive learning and heavy precepting so that all their questions can be answered right away. Once the successful ones have essentially exhausted the learning opportunities, usually within a couple of years, they start to sniff the air for better opportunities.

3. They think they should have a "life." The classic shift-weekend-holiday rotation will not cut it with this group. They are looking for a workplace that offers flexible scheduling, liberal vacations, daycare centers, workout

rooms, on-site drycleaning, florists, and the list goes on. They will pick the job that allows them to get the most fun out of life.

This laundry list is enough to send a Baby Boomer nurse, hands on hips, huffing out to the smoke shack. After all, they entered this profession knowing and expecting lifelong low salaries and hard work. Besides they believe that once a nurse, always a nurse. However, today new B.S.N. graduates can look to a bright future with any number of biotech or pharmaceutical organizations if care delivery does not appeal to them. Then there are those "travel agency" nursing opportunities whose recruitment ads read like a travel brochure and a Generation X manifesto:

Name your location

Name your specialty

Name your shift

Get paid incredible, above-market wages, premiums, and a sign-on bonus

All expenses paid

How are healthcare organizations responding to the phenomenal cultural influence? Who will be the 'hard sell'the executives and board or the older staff nurses? The executives will have to accept the necessity of such radical, and potentially expensive, changes in the work environment. The Baby Boomer nurses who have stuck it out for all these years and finally have the seniority to pick their shifts will need much mentoring to help them understand the need for a different, "kinder and gentler" workplace. The new mantra will need to be "Stop eating your young. They are your ticket to retirement!"

Across all generations, the literature points to communication as the key factor in retention-an old theme that lives on. In a 2001 article in Nursing Spectrum, author Carrie Farella lists seven nurse "cravings" that need to be satisfied to keep motivation high and to send morale soaring:

1. Talk with me. Nurses want their managers to communicate to them good or bad information. Having as many facts as possible about their work environment is essential. Whether the news is about reengineering of a unit or a high-level hospital merger, nurses appreciate managers who provide them with solid information about changes that may affect their jobs.

2. Work with me. Often balancing several tasks in the air at once (staffing, budgeting, and ordering supplies to name a few), managers who occasionally push their duties aside to lend a hand say patients and staff are better for it.

3. Stand up for me. When the chips are down, knowing the manager will defend staff nurses is important.

4. Know who I am. Knowing expectations outside of work can help a manager better understand staff at work.

5. Be with me. Whether sharing a cup of coffee after charting is completed or after the shift is over or having a catered lunch on the floor, gettogethers create solid bonds among nurses.

6. Help me grow. Just getting by is not enough any longer. Staff, par-ticularly the younger ones, craves professional development and a work environment that stimulates educational experiences.

7. Do make me laugh. Humor, laughter, and fun are very important in the workplace.

Corbo (1997) provides another list of Dos in her article "The Xer Files" Increase interpersonal skills. Many Baby Boomers were socialized during a time when keeping work life and personal life separate was a valued trait. In contrast, Generation Xers like to talk about personal issues but do so in a rather abrupt manner, lacking the social niceties Baby Boomers were trained to observe.

Provide individual attention. Generation Xers like individual attention. Providing a specified drop-in time will meet the Generation Xer's need for this type of attention while providing structure that soothes the Baby Boomer.

Use an abbreviated style. Generation Xers prefer brevity. They prefer to read about new procedures or policies, watch a video, or access information online. Drop the meeting requirements.

Appreciate diversity. Generation X is more culturally diverse and should be viewed as an asset in managing culturally diverse patient populations and workplace issues.

Use humor. Humor defines us as humans, brings out a personal and childlike part of us, and is an effective way to reduce stress.

Be empathetic. For many Generation Xers, navigating a career path has not been easy and that will not be changing soon. As a result, they stress personal happiness and the importance of holding a challenging and fulfilling job. An essential ingredient is to have coworkers and managers who are compassionate and understanding.

Do unto others. Generation Xers are eager to learn, especially about company politics and social graces to get ahead. No matter what your background or experience, you can always learn from others.

Retaining Baby Boomers

The final Dos surround the concept of retaining senior nurses on staff. Many Baby Boomers, whose existence surrounds work, are not expected to retire fully at retirement age. The healthcare industry should not encourage a mass exodus if it intends to have a safe ratio of nurse to patient. Johnson (2001) suggests several ways to keep senior nurses productive and effective:

Promote the benefits of working parttime instead of retiring.

Use senior nurses as trainers and planners, freeing up younger nurses for direct patient care.

Use senior nurses to staff community benefit and healthy communities programs.

Have senior nurses take courses in geriatric nursing and give "caregiver" programs.

. Have senior nurses teach or tutor high school students in science.

The challenges of recruiting a younger generation of nursing staff and meeting retention demands of crossgenerational needs will be a challenge like no other seen in healthcare. I hope that this summary sheds light on the signs that clearly mark the path of future successful staffing patterns and management styles.




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Judy A. Cordeniz, Seton Hall University, South Orange, New Jersey


For more information on this article, please contact Ms. Cordeniz at:

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