Perspectives of Generation Z Nurses in Succession in Nursing Management

INTRODUCTION

Demographic changes have also become strongly visible in the nursing profession. The nursing workforce currently consists of four generations of nurses: Baby boomers (1946–1964), Generation X (1965–1980), millennials or Generation Y (1981–1995), and Generation Z (1996–2009) (Hendricks, Cope, 2013; Yi et al., 2022). While reviewing the literature, we found that study authors do not agree on the classification of generational cohorts, but differences in the exact years are minimal. Likewise, Koníčková (2023) confirms that experts do not agree on the exact years, but regardless of differences in generational dating, it is clear that Generation Z is quite different from its parents. Hendricks and Cope (2013) define the generation as “an identifiable group that shares birth years and important life events in critical developmental stages.” They call such groups “generational cohorts.”

The other three decades had the greatest presence of Baby boomer nurses in nursing, most of whom are already retirees or planning retirement. Generation Y nurses, also called millennials, currently make up 30–50% of the workforce (Sherman et al., 2015). The new generation of Generation Z nurses brings new expectations and ideals about life and work into nursing practice (Hampton, Welsh, 2019).

Replacing nurses in leadership positions will be a demanding process, and therefore for the future of nursing management it is necessary to know the factors that would lead Generation Z nurses to take up leadership roles.

Effective succession planning is an implemented, documented program based on a process continuum that starts with recruitment, education, and training. Candidates for leadership roles are gradually exposed to increasingly demanding experiences and responsibilities, opportunities to develop and refine leadership abilities, mentoring and coaching, and acceptance of failure, whose result is learning. To call succession planning effective, it must lead to preserving organizational culture, continuity, and vision, supporting the organization in continuing to fulfill its mission. Effective succession planning includes actions, activities, and interventions aimed at ensuring that capable, motivated, and talented individuals are prepared to take on the leadership roles for which they were selected (Griffith, 2012).

In Table 1, we present the processed overview of findings on Generation Z as the result of a literature review, which we divided into four areas.

Table 1. Core characteristics of Generation Z

Source: adapted from foreign literature sources (Benítez-Márquez et al., 2021; Stiglbauer et al. 2022; Hampton, Welsh, 2019)

Generation Z (also known as iGen, net Generation, iGeneration, Gen Next, Gen Wii, Post Gen, Multi-Gen, Homeland Generation, and Plurals) is the first generation that has never known a time without the internet, because in roughly the same time period in which individuals of this cohort were born, the internet became increasingly publicly available. Therefore, there are many individualists among them, and they lack developed social and relational skills, which can lead to anxiety, insecurity, and depression (Chicca, Shellenbarger, 2019). This cohort was confronted with the global financial crisis, world terrorism, political instability, and the climate crisis. Generation Z lives in a globalized world with the same currency within the EU and free mobility across member states. All these factors affected the personalities of Generation Z individuals. The introduction of Generation Z nurses into the labor market was difficult because it was influenced by the pandemic. Cohort Z has high expectations of their work and will use advanced technology skills (Benítez-Márquez et al., 2021). Generation Z are realists, pragmatists, technology- and internet-dependent, with the majority online nine or more hours per day. For newly graduated nurses, the biggest source of anxiety is the transition from school to clinical practice. Since they have spent most of their time studying online, it is necessary for them to develop communication, social, and relational skills (Hilton, 2023).

AIM

To determine the interest, opinions, and attitudes of Generation Z nurses regarding succession in nursing management.

SAMPLE AND METHODOLOGY

We used triangulation of methods for data collection: the focus group method, structured interviews, and content analysis of checklists. The survey was carried out in February and March 2023 in three focus groups among a sample of forty nurses and simultaneously students of FZ TnUAD, master's study program in Nursing. The first focus group consisted of 16 nurses working in healthcare facilities in the Žilina Region. The second focus group was made up of 15 nurses working in healthcare facilities in the Trenčín Region. Nine nurses working in healthcare facilities in Bratislava, Nitra, and Trnava were included in the third focus group. Nurses born between 1996–2009, that is, those identified in the literature as Generation Z, were eligible to participate. The second purposive selection criterion was that they declared they were not holding a managerial position. The average age of the nurses was 24 years, with an average length of clinical practice of 2.3 years. All nurses had completed first-cycle university education. Before being divided into focus groups, participants completed a checklist containing ten items and three demographic fields. Four items were based on a 5-point Likert scale (1-disagree; 2-tend to disagree; 3-neutral; 4-tend to agree; 5-agree). The remaining items were open-ended and were part of the discussions within focus groups.

The Focus Groups method reveals participants' attitudes, experiences, and opinions and also tracks mutual reactions among participants. The method is based on group discussion moderated by a facilitator (the article author), using group interaction to obtain data and insights about the topic from participants. Nurses were divided into three groups by place of practice and color-coded: the first focus group-red, the second group-green, and the third group-blue. A note-taker was selected in each group. The recommended duration for focus groups (2–3 hours) was followed. Participants evaluated this process, the focus method, and their participation in the study very positively as meaningful.

By applying the Focus Groups method in nursing, applied knowledge is generated. This was followed by coding of responses and data from the focus groups; analysis and interpretation of focus-group data. We established analytical categories: 1. stimulants for accepting a managerial position, 2. factors for rejecting a managerial position, 3. managerial nurse activities by importance, 4. contribution of the managerial position, and 5. areas of support after accepting a managerial role. The collected data are presented in summary tables. In the case of cardinal data, we report descriptive statistics in the form of number of respondents, arithmetic mean, standard deviation, median, minimum and maximum values, and variance.

RESULTS AND DISCUSSION

The focus groups were conducted to obtain an overview of factors that would lead Generation Z nurses to accept or reject a management position. Key study areas were findings related to motivational factors for accepting a leadership role. In the first analytical category we present in Table 2 motivational factors for accepting a managerial position. The decisive stimuli for Generation Z nurses would be a higher salary (x̄ = 4,775 of 5; sd = 0.523), career growth (x̄ = 4,725 of 5; sd = 0.446), gaining managerial experience (x̄ = 4.6 of 5; sd = 0.489), the possibility of changing nursing management in practice (x̄ = 4,425 of 5; sd = 0.627), and meaningful work (x̄ = 4,075 of 5; sd = 0.685). In a control question during structured interviews we asked what would influence their decision to accept an offered managerial position on the day the focus meetings were held. Motivational stimuli for accepting a managerial role were salary (n = 30), working time (n = 15), and career growth (n = 13). In terms of comparison between individual focus groups, we did not observe pronounced differences in stimuli. Generation Z nurses expect flexible working time, benefits, a pleasant work environment with modern technology (Sherman, Cohn, 2022).

Table 2. Motivational factors/stimuli for accepting a managerial position

Legend: n – number of respondents, x̄ – arithmetic mean, sd – standard deviation, xm – median, min. – minimum value, max. – maximum value, mod(x) – mode, s2 – variance.

The next question investigated in which area of a manager’s work they would welcome help and support from an experienced manager during the early phase of their managerial activity. The dominant area was financial management and budget planning (n = 20), with participants reporting concerns stemming from significant material responsibility. Administrative activities (n = 17) were also considered highly demanding by the nurses, which we relate to Generation Z characteristics and difficulties with writing texts. Nurses identified administrative support as a need for help from an experienced manager with strong administrative skills.

Managerial communication (n = 11) as the third preferred area of help and support is connected to Generation Z fear of speaking face to face; they are used to communicating only through social networks. Time management and motivating subordinates were also frequently mentioned areas of support. The responses of Generation Z nurses corresponded with findings concerning reasons for rejecting leadership roles.

The results of processed data from the second analytical category—factors for rejecting a managerial position—are presented in Table 3. The most frequent reasons for refusing a leadership position were taking on high responsibility (x̄ = 3,775 of 5; sd = 1.036), which is associated with a managerial role, fear of failure (x̄ = 3,75 of 5; sd = 1.089), inability to handle a managerial role, great concern about not managing financial management and budget planning (x̄ = 3,675 of 5; sd = 1.081), which participants linked to low financial literacy. Significant factors for refusal also included stress, loss of clinical skills, administrative tasks, work-life imbalance, and job insecurity. The same findings were reached during interviews. The most common reasons for rejecting a managerial position reported by focus group participants were lack of managerial knowledge and experience (n = 14), high responsibility (n = 14), and fear. Altogether, 25 participants would reject the managerial position.

Table 3. Factors for rejecting a managerial position

Legend: n – number of respondents, x̄ – arithmetic mean, sd – standard deviation, xm – median, min. – minimum value, max. – maximum value, mod(x) – mode, s2 – variance.

Lund and Thomas (2012) note that in the coming years higher management positions will experience extreme turnover, creating a major opportunity for leaders of the new generation. HR specialists, however, already warn that Generations Y and Z have insufficient self-confidence to hold higher managerial positions. The phenomenon of leadership succession in nursing will affect all generations and change healthcare overall, because Generation Z has entered the labor market. Several international studies have indicated that nurses are not interested in taking up leadership positions. The authors conducted research in Oregon with a sample of 1201 nurses. Fifty-three percent of respondents would be interested in a managerial position. Significant motivational predictors were years of practice, preparation for leadership, salary level, and benefits. The authors recommend that current nursing managers improve nurses' attitudes toward management by increasing their participation and involvement in everyday management activities, providing them with education and support (Al sabei et al., 2018). Employers can support Generation Z nurses through training and coaching in leadership, developing problem-solving and decision-making skills, teamwork, communication skills, providing opportunities to advance within the organization, work-life balance, better or more competitive pay and benefits, respect, recognition, and access to educational and development opportunities (Stanley, 2010).

In the last decade, there has been an increasing number of studies addressing generational differences in work values, especially focusing on managerial interests. Current evidence shows that the entry of Generation Z, also called post-millennials, into the labor market creates certain tension. This young working generation behaves more narcissistically, is more emotionally labile, focused on success and social connections. Generation Z nurses place great emphasis on two work values: personal development and relationships. This is not surprising because they are at the beginning of their careers. Also, Generation Z’s high emphasis on workplace relationships may represent age-related preference for intensive social exchange. Generation Z wants to be motivated by financial rewards, and wants diversity in work with stimuli, challenges, and novelty. Findings and conclusions from many studies emphasize the need for a new leadership style (Stiglbauer et al., 2022). Generational theory suggests that work values change with the arrival of Generation Z, which has so far been relatively under-researched (Maloni et al., 2019). Hampton and Welsh (2019), in their cross-sectional study, found that the most important work values of Generation Z nurses were helping people and having work that is interesting and engaging while also offering employment security and good benefits. Yi et al. (2022) define work values as “values that individuals consider important to their work (e.g., salary, working conditions, autonomy). When individuals’ work values are satisfied, they show higher job satisfaction and are less likely to leave their job. Work values serve as criteria for evaluating jobs and work environments that guide employees’ work-related decisions and motivate their actions, whether applying for a job or leaving one, or even accepting one job over another.” A U.S. study of 525 Generation Z nursing students concluded that the most important work values were helping people, having interesting and engaging work, having employment stability, and benefits (Yi et al., 2022).

We were interested in how Generation Z nurses evaluate the activities and tasks of nursing managers by importance. Nurses were asked to rank responses from 1 to 8, where 1 was the most important task and 8 the least significant task. Generation Z nurses consider the most important task of a nursing manager to be management of the nursing unit and the least important to be supervision (Table 4).

Table 4. Evaluation of nursing management activities by importance

Legend: x̄ – arithmetic mean

A nurse manager at every level of nursing leadership should plan for succession and involve selected nurses in managerial activities, because if nurses have limited opportunity to observe their superiors in day-to-day activities, they will not understand key tasks and responsibilities, such as financial management. Generational differences pose challenges for current nursing managers. Managing nurses who think and behave differently due to different fundamental personal and generational values—especially in communication, engagement, and remuneration—requires managers to understand the relationship between different personal characteristics and approaches to work that are unique to each generation, and to understand how life experiences influence basic personal values and the work ethic that shapes professional work behavior.

The composition of the nursing workforce includes a mix of generational cohorts. This mix requires different communication approaches, different engagement methods, and different ways of rewarding, and therefore tends toward conflict in workplace relationships (Hendricks, Cope, 2013). Generation Z became a major focus of research more notably from 2018. There is a need for further studies in various aspects concerning Generation Z nurses in the labor market. This generation is motivated by the search for their dream job and opportunities to expand their skills, will change jobs more frequently than preceding generations, and if they are dissatisfied with something, they are prepared to leave the workplace immediately and look for other opportunities in the labor market. Motivational factors for this cohort are promotion opportunities, salary increase, meaningful work, and team environment (Benítez-Márquez et al., 2021).

Our aim was also to identify what the study participants would see as their contributions after taking a managerial position in nursing management (Table 5). Nurses said they would like to support their subordinates (x̄ = 4,8 of 5; sd = 0.509), would like to initiate changes in nursing (x̄ = 4,75 of 5; sd = 0.433), would like to be a role model for their subordinates (x̄ = 4,675 of 5; sd = 0.565), and support collaboration in the team.

Table 5. Contribution of the managerial position

Legend: n – number of respondents, x̄ – arithmetic mean, sd – standard deviation, xm – median, min. – minimum value, max. – maximum value, mod(x) – mode, s2 – variance.

Generation Z nurses need mentorship and feedback from current nursing managers. From the analysis of data from the three focus groups, we recommend that nursing managers develop and implement succession plans and prepare nurses showing leadership potential for the tasks required in managerial positions.

Sherman and Cohn (2022) state that the recruitment of new nurses has also changed in recent years. Most new employees are in the millennial or Generation Z cohorts. This trend will continue because Baby boomers will leave this profession over the next 5 years. Generation Z nurses have different expectations of employers than previous generations, and recruitment strategies used in the past may no longer be effective. Most applicants have limited or no work experience in nursing practice, and a new graduate who takes a job will likely stay no longer than two years. Young nurses do not consider nursing a lifelong career and expect managers to coach them to achieve their professional goals. Many authors recommend using social media for effective recruitment.

CONCLUSION

The future of nursing management is expected to undergo significant transformation. Planning the delivery of nursing care will require, from a futurological perspective, new and strong nursing leadership. Generation Z nurses have specific expectations of work, and if these are not met, they will leave the profession. Findings from this study provide valuable insight into the views and attitudes of this generation of nurses and may significantly help current nursing managers create appropriate strategies to retain them in practice and plan succession. Succession programs should focus on identifying and preparing candidates for succession, managerial competencies, and implementation processes for succession planning programs. It is also necessary to consider the consequences of succession and the readiness or lack of readiness of Generation Z nurses for the future of nursing management and for healthcare institutions as well.

Nursing managers must plan succession at all levels of management. The current and anticipated global nursing shortage, along with economic, political, and social factors affecting nursing care delivery, make effective succession planning an absolute necessity for the nursing profession (Griffith, 2012).

Research limitations

Interpretation of study results, representativeness of findings, and their applicability in a global context are limited by the sample size of Generation Z nurses at the beginning of their careers. Even so, the findings are valuable for creating a consolidated picture of issues concerning Generation Z nurses in managerial practice.

doc. PhDr. Viera Hulková, PhD., MPH Fakulta zdravotníctva, Trenčianska univerzita Alexandra Dubčeka v Trenčíne

The contribution was created with support from the VEGA project: Economic aspects of migration of graduates of health sciences in higher education in the context of sustainability of personnel provision in healthcare facilities in the Slovak Republic. Project registry number: VEGA no. 1/0691/22

LIST OF BIBLIOGRAPHIC REFERENCES

AL SABEI, SD., ROSS,AM., LEE, CHS. Factors influencing nurses’ willingness to lead. Journal of Nursing Management. 2018; doi.org/10.1111/jonm.12698

BENÍTEZ-MÁRQUEZ, MD, SÁNCHEZ-TEBA, EM, BERUDEZ-GONZÁLEZ, G., NUNEZ-RYDMAN, ES. Generation Z Within the Workforce and in the Workplace: A Bibliometric Analysis. Front Psychol. 2022;12:736820. doi: 10.3389/fpsyc.2021.736820.

CHICCA, J., SHELLENBARGER, T. A new generation of nurses is here. Strategies for working with Generation Z. American Nurse Today. 2019. 14(2): 48-50

GRIFFITH MB. Effective succession planning in nursing: a review of the literature. Journal of Nursing Management. 2012; 20 ( 7 ): 900 – 911. doi: 10.1111/j.1365-2834.2012.01418.x

HAMPTON, D., WELSH, D. Work Values of Generation Z Nurses. JONA: The Journal of Nursing Administration.2019; 49(10):480-486. doi: 10.1097/NNA.0000000000000791

HENDRICKS, JM, COPE, VC. Generational diversity: what nurse managers need to know. Journal of Advanced Nursing. 2013; 69 (3): 717-725.doi:10.1111/j.1365–2648.2012.06079.x

HILTON, L. Generation Z Nurses Brings perspective healthcare. 2023. [online]. [Cited: 20.07.2023]. Available at: Nurse.com.

KONÍČKOVÁ, J. What is Generation Z? 2023. [online]. [Cited: 20.07.2023]. Available at: www.eduworld.sk

LUND, BL., THOMAS, RE. Advice for Tomorrow's Leaders: Millennial Leadership during the Leadership Succession Crisis. Leadership & Organizational Management Journal. 2012. [online]. [Cited: 20.07.2023]. Available at: www.ebsco.com

MALONI, M., HIATT, MS., CAMPBELL S. Understanding the work values of Gen Z business students. Int J Manag Educ. 2019; 17(3):100320.

SHERMAN, RO, SAIFMAN, H., SCHWARTZ RC., SCHWARTZ CHL. Factors that lead Generation Y nurses to consider or reject nurse leader roles. NursingPlus Open. 2015; 1: 5-10. doi.org/10.1016/j.npls.2015.05.001

SHERMAN, RO., COHN, TM. Recruiting Millennial and Gen Z nurses. 2022. [online]. [Cited: 20.07.2023]. Available at: www.myamericannurse.com

STANLEY, D. Multigenerational workforce issues and their implications for leadership in nursing. Journal of Nursing Management. 2010;18: 846-852.

STIGLBAUER, B., PENZ, B., BATINIC, B. Work values across generations: Development of the New Work Values Scale (NWVS) and examination of generational differences. Front.Psychol. 2022; 13. doi.org/10.3389/fpsyg.2022.1028072

YI, S., CASEY, M., MICAH DJP. What are the work values of Generation Z nurses? Australian Nursing & Midwifery Journal. 2022. [online]. [Cited: 20.07.2023]. Available at: www.anmj.org.au