Organisational Rules and Technologies from the Perspective of Generations of Nurses

Organisational Rules and Technologies from the Perspective of Generations of Nurses

Introduction

Changes in work organisation are a natural part of nursing practice, and their acceptance is influenced by nurses' attitudes and workplace conditions. Cheraghi et al. (2023) found that nurses' resistance to change is related to individual, interpersonal, and organisational factors. A significant part of changes in nursing practice is the introduction of technologies. According to Cachata et al. (2024), the integration of information technologies requires organisational readiness, clearly defined procedures, management support, and continuous development of nurses' skills. Schlicht et al. (2025), in an umbrella review encompassing 213 review papers, noted favourable effects of digital technologies on performing nursing tasks, information management, work control, and nurses' professional competence; negative effects mainly concerned workload, frustration, fatigue, and burnout. The importance of nurses' attitudes towards technologies was highlighted by Bloomfield et al. (2023). In a sample of 120 nurses, they identified a positive relationship between online self-regulated learning and attitudes towards e-learning (r = 0.663; p < 0.001), with attitudes towards e-learning being a significant predictor of attitudes towards information and communication technologies in healthcare (R² = 0.306; p < 0.001). Bimerew (2024) included workload, time constraints, insufficient access to computers, and lack of skills among barriers to adopting digital technologies, while positive attitudes and self-confidence supported their use. Comparcini et al. (2025), in a sample of 551 nurses, pointed to a connection between digital health literacy and level of education, professional role, habits, and attitudes towards digital technologies. Nurses in managerial positions and with postgraduate education used digital resources more frequently. Amin et al. (2025), among 500 nurses, found that positive attitudes towards artificial intelligence were related to lower resistance to change and positively correlated with perceived usefulness and ease of use of artificial intelligence, self-efficacy for change, and organisational support. Current nursing teams are characterised by generational diversity, which may translate into different work values, attitudes, and expectations of nurses. Miller and Steuber (2025) emphasise the importance of considering generational specifics when leading nursing teams and supporting intergenerational collaboration. Generational differences therefore need to be assessed in relation to specific work attitudes of nurses.

Objective

The aim of our study was to analyse the attitudes of nurses from different generations towards organisational rules and technologies.

Sample and Methodology

The sample consisted of 251 nurses from various types of healthcare facilities in Slovakia and the Czech Republic, obtained through purposive sampling. According to the McCrindle Research classification, 58 (23.1%) respondents were classified as Baby Boomers, 65 (25.9%) as Generation X, 62 (24.7%) as Generation Y, and 66 (26.3%) as Generation Z. Data were collected using an adapted Slovak version of the standardised instrument The Work Value and Attitude Scale (Tan, Chin, 2023). Consent for its use, translation, adaptation, and electronic distribution was obtained from the lead author of the original instrument. The adapted version consisted of 4 demographic and 25 assessment items arranged into seven factors, rated on a five-point Likert scale from 1 – strongly disagree to 5 – strongly agree. The present analysis processed two factors – "non-compliance with rules", consisting of four items, and "technology as a challenge", consisting of three items. Data were collected electronically via Google Forms from 8 October to 2 December 2025. Statistical processing was performed using jamovi 2.7 for macOS. Descriptive data are presented as arithmetic mean (M). The Kruskal-Wallis test was used to compare generational cohorts, and when a statistically significant difference was found, pairwise comparison followed using Dunn's post-hoc test with Bonferroni correction. The level of statistical significance was set at p < 0.05.

Results

Table 1 Generational differences of nurses in attitudes towards organisational rules

Legend: BB – Baby Boomers; X – Generation X; Y – Generation Y; Z – Generation Z; M – arithmetic mean; χ² – Kruskal-Wallis test value; p – level of statistical significance.

In attitudes towards organisational rules, statistically significant differences were found between generational cohorts in all monitored items (p < 0.001). A statistically significant difference was recorded in cynical attitude towards management (χ² = 31.529; p < 0.001), with Generation Z achieving the highest mean rating (M = 2.62) and Baby Boomers the lowest (M = 1.83). A significant difference was also found in low tolerance for bureaucracy and rules (χ² = 30.630; p < 0.001), where Generation Z achieved the highest mean rating (M = 2.95) and Generation Y the lowest (M = 2.13). Statistically significant differences were also demonstrated in the attitude that rules are meant to be broken (χ² = 24.122; p < 0.001) and in questioning workplace norms (χ² = 20.174; p < 0.001). In both items, Generation Z achieved the highest mean rating (M = 2.12; M = 2.71) and Baby Boomers the lowest (M = 1.57; M = 1.91).

Table 2 Generational differences of nurses in attitudes towards technologies

Legend: BB – Baby Boomers; X – Generation X; Y – Generation Y; Z – Generation Z; M – arithmetic mean; χ² – Kruskal-Wallis test value; p – level of statistical significance.

In attitudes towards technologies, statistically significant differences were found between generational cohorts in all monitored items. A statistically significant difference was recorded in the evaluation of using the latest technology as a means of facilitating work (χ² = 38.838; p < 0.001), with Generation Z achieving the highest average rating (M = 4.21) and Generation X the lowest (M = 3.25). A statistically significant difference was also demonstrated for the statement that technologies make work more difficult (χ² = 38.508; p < 0.001), where Baby Boomers achieved the highest average rating (M = 2.41) and Generation Z the lowest (M = 1.62). A difference between generational cohorts was also found in the fear of being replaced by a computer (χ² = 9.515; p = 0.023), with Generation X achieving the highest average rating (M = 1.94) and Generation Y the lowest (M = 1.52).

Table 3 Pairwise comparison of generational cohorts in attitudes towards organizational rules

Legend: BB – Baby Boomers; X – Generation X; Y – Generation Y; Z – Generation Z. Shown are p-values of Dunn's post-hoc test after Bonferroni correction.

Analysis using Dunn's post-hoc test with Bonferroni correction demonstrated statistically significant pairwise differences in all monitored items. Regarding questioning workplace norms, a difference was confirmed between the Baby Boomers generation and Generation Z (p < 0.001). For the attitude that rules are meant to be broken, statistically significant differences were found between Baby Boomers and Generation X (p = 0.035), Baby Boomers and Generation Z (p < 0.001), and between Generations Y and Z (p = 0.005). For low tolerance towards bureaucracy and rules, significant differences were demonstrated between Baby Boomers and Generation Z (p < 0.001), X and Z (p = 0.046), and Y and Z (p < 0.001). The same profile of pairwise differences was recorded for the cynical attitude towards management, where Generation Z differed statistically significantly from Baby Boomers (p < 0.001), Generation X (p = 0.006), and Generation Y (p < 0.001). In the remaining pairwise comparisons, no statistically significant differences were demonstrated after Bonferroni correction (p > 0.05).

Table 4 Pairwise comparison of generational cohorts in attitudes towards technologies

Legend: BB – Baby Boomers; X – Generation X; Y – Generation Y; Z – Generation Z. Shown are p-values of Dunn's post-hoc test after Bonferroni correction.

For the statement that technologies make work more difficult, differences were confirmed between Baby Boomers and Generation Y (p = 0.012), Baby Boomers and Generation Z (p < 0.001), and between Generations X and Z (p < 0.001). Regarding the fear of being replaced by a computer, only Generations X and Y differed statistically significantly (p = 0.023). In the evaluation of using the latest technology as a means of facilitating work, statistically significant differences were demonstrated between Baby Boomers and Generation Z (p < 0.001), X and Y (p = 0.019), and X and Z (p < 0.001). In the remaining pairwise comparisons, no statistically significant differences were demonstrated after Bonferroni correction (p > 0.05).

Discussion

In our study, generational differences were demonstrated in all observed attitudes towards organizational rules, with a more critical attitude towards rules, bureaucracy, and management being characteristic especially of Generation Z. Similarly, Tan and Chin (2023) in a sample of 778 nurses demonstrated a generational difference in the construct of rule-breaking (p = 0.007), with Generation X having a lesser tendency to question established norms and superiors. Al-Moteri et al. (2025), when examining the work preferences of Generation Z, identified six factors explaining 62.21% of the variability, of which the factor of bureaucratic resistance and criticism of technologies explained 8.19%. Hulková (2024) describes the characteristics of this generation with regard to work. She states that Generation Z wants the certainty of interesting work, benefits, a non-traditional work environment with flexibility. She refers to this generation as "digital people." Moon and Lee (2025), in a qualitative study of 17 Generation Z nurses, described the adaptation process in a vertical organizational culture, during which nurses went through phases of chaos, efforts to adapt, and acceptance of themselves. When managing work tasks, they felt uncertainty, avoided stressors, and strived to increase their competence, with a sense of belonging and achievement playing a significant role in the adaptation process. Our findings can thus also be interpreted in the context of the importance of the organizational environment for the work attitudes of Generation Z nurses. However, a critical attitude towards rules cannot be automatically equated with their violation. De Kok et al. (2023) describe so-called rebellious leadership, in which nurses question established practices, professional norms, or organizational rules that they do not consider appropriate or effective, while such behavior can be perceived as an impetus for improving care, but also as a disruption to the functioning of the organization. Generational differences may not manifest equally in all areas of nurses' work attitudes. Lee and Lee (2023), in a sample of 159 nurses, found differences in job satisfaction (F = 3.492; p = 0.03) and organizational commitment (F = 4.371; p = 0.01), but not in work values (F = 0.765; p = 0.47) or types of communication (F = 1.744; p = 0.18). Kim et al. (2024), comparing 151 Generation Y nurses and 129 Generation Z nurses, found no significant differences in work values or job satisfaction; however, the factors related to job satisfaction were different for both generations. We observed a similar selectivity of generational differences in a previous analysis of the same sample of 251 nurses, where differences were demonstrated in the need for clear guidance (χ² = 16.764; p < 0.001) and the tendency to assume a leadership role in the team (χ² = 10.060; p = 0.018), while statistically significant differences in attitudes towards autonomy and proactive action were not confirmed (p > 0.05) (Katriňáková et al., 2026). Therefore, generational differences cannot be generalized to all work attitudes of nurses. Regarding attitudes towards technologies, Generation Z least perceived technologies as a factor complicating work (M = 1.62) and, at the same time, most strongly evaluated them as a means facilitating work activities (M = 4.21). The results correspond with the findings of Tan and Chin (2023), who demonstrated a generational difference in the construct of technology as a challenge (p = 0.027) and pointed to the higher technological proficiency and adaptability of Generations Y and Z. The importance of age in the adoption of technologies was also noted by Xie et al. (2025). In a sample of 1,395 nurses and other nursing staff, 78.9% declared an intention to use digital information technologies, but 44.9% were frequent users; education and professional training were also significant. Mirabootalebi et al. (2025) similarly found an association of age with the perceived ease of use of mobile applications (p = 0.012), while education was related to technological anxiety (p = 0.039) and perceived security risk (p = 0.015). Therefore, generational differences in attitudes towards technologies cannot be explained in isolation from the age, education, and experience of nurses with technologies. Bimerew (2024) highlights the importance of working conditions; in a sample of 93 nurses, he included workload, time constraints, insufficient access to computers, and lack of skills among the barriers to adopting digital technologies. Schlicht et al. (2025), in an umbrella review encompassing 213 review papers, noted positive effects of digital technologies on the performance of nursing tasks, information management, work control, and professional competence, but also negative consequences in the form of workload, frustration, fatigue, and burnout. Therefore, the perception of technologies as facilitating or complicating work may, in addition to generational affiliation, also be related to the conditions of their implementation into clinical practice. We observed a different trend regarding the fear of replacement by a computer, where in pairwise comparison only Generations X and Y differed significantly (p = 0.023), and the level of agreement was low across all generational cohorts. Amin et al. (2025), in a study of 500 nurses, found that positive attitudes towards artificial intelligence were associated with lower resistance to change, while among the barriers, nurses cited insufficient knowledge, technological problems, inadequate training, and concerns about the replacement of human interaction by technologies. In our sample, the fear of technological replacement thus did not represent a dominant attitude; more pronounced generational differences concerned whether nurses perceived technologies as a burden or as a means facilitating work.

Conclusion

The results pointed to different attitudes of generational cohorts towards the observed aspects of work organization and the use of technologies. In our sample, a more critical attitude towards rules, bureaucracy, and management was manifested especially in Generation Z, which also perceived the use of technologies in the work process more favorably. The identified differences point to the need to adapt the management of nursing teams to a generationally diverse work environment. In the area of organizational rules, we recommend clearly communicating their meaning and justification, creating space for nurse feedback, and involving them in the modification of work procedures. Particularly with younger nurses, it may be beneficial to support open communication with management and allow for constructive pointing out of ineffective or administratively burdensome procedures. When introducing new technologies, we recommend leveraging the more favorable attitudes of technologically more open nurses through peer learning and support for colleagues who perceive technologies as more challenging. At the same time, it is necessary to ensure practical training and sufficient support during the implementation of technologies, regardless of generational affiliation. Regularly surveying nurses' attitudes towards organizational rules and technologies can help management identify areas that are sources of resistance or workload and respond to them purposefully in the organization and management of nursing practice.

Authors:
prof. PhDr. Mária Kilíková, PhD., MPH

St. Elizabeth University of Health and Social Work in Bratislava, n. o. Detached Workplace of Bl. Sára Salkaházi in Rožňava

PhDr. Katriňáková Tatiana
St. Elizabeth University of Health and Social Work in Bratislava, n. o. Detached Workplace of Bl. Sára Salkaházi in Rožňava

Mgr. Maximilián Beraxa
St. Elizabeth University of Health and Social Work in Bratislava, n. o.

List of Bibliographic References

AL-MOTERI, M. et al. 2025. The workplace expectations and preferences of Gen Z nurses: exploratory factor analysis. BMC Nursing [online]. 2025⁏ 24 (1): 1121. [cit. 2026-09-28]. ISSN 1472-6955. Available at: .

AMIN, S. M. et al. 2025. Sentiment of Nurses Towards Artificial Intelligence and Resistance to Change in Healthcare Organisations: A Mixed-Method Study. Journal of Advanced Nursing [online]. 2025⁏ 81 (4): 2087–2098. [cit. 2026-09-28]. ISSN 1365-2648. Available at: .

BIMEREW, M. 2024. Barriers and Enablers of Nurses' Adoption of Digital Health Technology to Facilitate Healthcare Delivery in Resource-Limited Settings. Studies in Health Technology and Informatics [online]. 2024⁏ 315: 64–68. [cit. 2026-09-28]. ISSN 1879-8365. Available at: .

BLOOMFIELD, J. G. et al. 2023. Registered nurses' attitudes towards e-learning and technology in healthcare: A cross-sectional survey. Nurse Education in Practice [online]. 2023⁏ 69: 103597. [cit. 2026-09-28]. ISSN 1471-5953. Available at: .

CACHATA, D. et al. 2024. The Integration of Information Technology in the Management and Organization of Nursing Care in a Hospital Environment: A Scoping Review. International Journal of Environmental Research and Public Health [online]. 2024⁏ 21 (8): 968. [cit. 2026-09-28]. ISSN 1660-4601. Available at: .

CHERAGHI, R. et al. 2023. Reasons for resistance to change in nursing: an integrative review. _BMC Nursing [online]. 2023⁏ 22 (1): 310. [cit. 2026-09-28]. ISSN 1472-6955. Available at: .

COMPARCINI, D. et al. 2025. The Relationship Between Nurses' Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross-Sectional Study. Journal of Clinical Nursing [online]. 2025⁏ 34 (7): 2885–2897. [cit. 2026-09-28]. ISSN 1365-2702. Available at: .

DE KOK, E. et al. 2023. Understanding rebel nurse leadership-as-practice: Challenging and changing the status quo in hospitals. Nursing Inquiry [online]. 2023⁏ 30 (4): e12577. [cit. 2026-09-28]. ISSN 1440-1800. Available at: .

HULKOVÁ, V. 2024_. Generational Diversity in Nursing – A Challenge for Education, Practice and Management._ Trenčín : Trenčín University of A. Dubček, Faculty of Health, 2024. 134p. ISBN 978-80-8295-014-7.

KATRIŇÁKOVÁ, T. KILÍKOVÁ, M. BERAXA, M. Generational Diversity of Nurses in the Context of Leadership and Professional Preparedness for Crisis Conditions. In: Resilience of Education and Science under Martial Law: Current Challenges and Strategic Solutions: International Conference, 19 September 2026 [online]. Lviv – Toruń: Liha-Pres, 2026, pp. 9–16. [cit. 2026-09-28]. ISBN 978-966-397-651-8. Available at: .

KIM, E. KIM, H. LEE, T. 2024. How are new nurses satisfied with their jobs? From the work value perspective of Generations Y and Z nurses. BMC Nursing [online]. 2024⁏ 23 (1): 252. [cit. 2026-09-28]. ISSN 1472-6955. Available at: .

LEE, S. A. LEE, J. 2023. Differences in occupational values, communication types, job satisfaction, and organisational commitment among clinical nurses across generations. Frontiers in Psychology [online]. 2023⁏ 14: 1174197. [cit. 2026-09-28]. ISSN 1664-1078. Available at: .

MILLER, R. STEUBER, A. 2025. Bridging Generational Gaps to Build and Sustain Healthy Work Environments in Nursing Practice. Critical Care Nursing Clinics of North America [online]. 2025⁏ 37 (4): 665–675. [cit. 2026-09-28]. ISSN 1558-3481. Available at: .

MIRABOOTALEBI, N. et al. 2025. The Moderating Effects of Demographic and Individual Characteristics on Nurses' Adoption of Mobile Applications. Studies in Health Technology and Informatics [online]. 2025⁏ 323: 248–252. [cit. 2026-09-28]. ISSN 1879-8365. Available at: .

MOON, Y. LEE, S. 2025. Experiences of Generation Z Nurses Adapting to Work in a Tertiary Hospital: A Grounded Theory Study. Journal of Advanced Nursing [online]. 2025⁏ 81 (4): 2050–2060. [cit. 2026-09-28]. ISSN 1365-2648. Available at: .

SCHLICHT, L. et al. 2025. Digital technologies in nursing: An umbrella review. International Journal of Nursing Studies [online]. 2025⁏ 161: 104950. [cit. 2026-09-28]. ISSN 1873-491X. Available at: .

TAN, S. H. E. CHIN, G. F. 2023. Generational effect on nurses' work values, engagement, and satisfaction in an acute hospital. BMC Nursing [online]. 2023⁏ 22 (1): 88. [cit. 2026-09-28]. ISSN 1472-6955. Available at: .

XIE, H. ZHANG, P. ZHU, W. 2025. Perceived acceptance, intention to use and actual use behavior of digital information technologies among nursing professionals in Shanghai: a cross-sectional study. BMC Nursing [online]. 2025⁏ 24 (1): 431. [cit. 2026-09-28]. ISSN 1472-6955. Available at: .