Chapter 1: Introduction to Dissertation
The purpose of this proposed Phenomenological study is to identify and understand the impact teaching methodologies, engagement, development, and leadership has on millennial nurse retention. The foundational impact on a Magnet hospitals’ ability to retain their nurses lies heavily in their registered nurse residency programs, and continued development. Millennial nurses need to be engaged and learning constantly. This study is to determine and understand if there is a correlation between teaching, developing, and engaging millennial nurses and retaining them at magnet hospitals. Themes and topics were identified through intense research linking learning differences, engagement, millennial values, and nurse retention. Retention statistics are being examined using traditional teaching and development methods, and interactive learning. The study will examine Millennial learning behaviors and how it relates to retention.
In the United States there is a large population of Registered Nurses. As of 2012 the total number of nurses was estimated to be almost 3 million (Sonenshine, 2014). The nursing profession is one of the fastest growing occupations in the United States; it is estimated that by 2022 there will be a need for approximately 3.44 million nurses in the United States (Sheffield, 2016). The demand for nurses continues to climb, while the number of professional nurses continues to decrease. Today’s nursing workforce is multigenerational, with Millennials accounting for the majority of today’s nurses. Millennials are the second largest generational cohort in the general population today (Raines, 2002). Millennial nurse retention is an important step to addressing the increasing nurse shortage.
There are many contributing factors to turnover in nursing. During a time when there is an increase in retirement it is exponentially important that nursing and hospital leadership are cognizant of factors that lead to turnover. One of the largest struggles for new graduate or Nurse Residents is the transition to floor nursing. They have an increased amount of stress, anxiety, and feel under prepared (Sheffield, 2016). To address this initial concern many hospitals have created Registered Nurse Residency programs. This practice is common at Magnet hospitals. The Magnet hospitals are the one which are awarded a status given by the American Nurses Credentialing Center (ANCC), which is an affiliate to American Nurses Association, for statsfying a set of criteria designed to measure the strength and quality of their nursing. Magnet status hospitals are successful because of their quality of care and ability to recruit and retain nurses (Beechcroft et al, 2008). With the increase of Millennials in the nursing workforce it is imperative that the Nurse Residency and development opportunities continue to increase, and focus on Millennial needs and values in order to engage and retain these nurses (Sheffield, 2016).
As the millennial generation enters the nursing field and penetrates the workforce it is essential to understand their values, needs and expectations. The average tenure for a millennial worker with their company is two years (Fromm, 2015). Millennials have a very independent mindset, and continue to look for opportunities to develop to advance their careers. Millennials have grown up during the digital era, where information, communication, and resources are at their fingertips. According to Fromm (2015), Millennials are efficient problem solvers, and critical thinkers. Two skills that are essential in the field of nursing. Millennials want to earn a good living, while doing work that matters (Gross, 2012). Millennials require opportunity to learn, develop, collaborate, have balance, and utilize technology in the workplace. Millennials need the freedom of choice and may challenge traditional methods of achieving outcomes (Gross, 212). Millennials will change the field of nursing, and force hospitals to re-evaluate their methods of training and development if they want to retain them.
Healthcare and nursing is expected to have the fastest employment growth and add the most jobs. The United States has been dealing with a growing nurse shortage due to the aging population and the rise of chronic diseases (Grant, 2016). The capacity of nursing schools has been a contributor in the nursing shortage. There are nearly three million nurses in the United States, and according to the bureau of labor and statistics 1.2 million vacancies will emerge for registered nurses between 2014 and 2022 (Grant, 2016). The nursing shortage in the United States has been increasing for a long period of time.
There has been a dramatic progress in field of nursing in United States. A nursing shortage has occurred several times throughout the history of Nursing in the United States, but for different reasons. The modern nursing shortage is a result of many factors; recruitment, retention, and work environment are among the historical contributors to the ongoing problem (West et al, 2014). The profession of nursing has evolved from a vocation, to comfort care for the dying, to a highly skilled profession. Nurses continue to use technologically advanced practices and there is a need for technological skills (West et al, 2014).
Historically, the profession of nursing has faced adverse and challenging environments that have led to a shortage in nurses. In the 1940s a survey was conducted to better understand why nursing students left the field. The results indicated during those times priority was given to tidying the beds and lockers over patient care, the frequency of missed meals, low wages, the training and education provided, and balance between work and life (West et al, 2014). The more modern shortages are a combination of recruitment, nursing education, retention, and work environment.
Retaining nurses has been a concern for hospitals throughout the evolution of this profession. According to Goodwin (2002), to retain Registered Nurses hospitals have to provide developmental opportunities to help advance their careers and lifelong learning. This is exponentially important to the Millennial nurse population. Advances in nursing education have cause nurse educators and hospital leadership to reevaluate the education, training, and development provided. Today, having a multigenerational workforce in nursing has required a thorough evaluation of teaching methodologies used, as well as retention planning.
The millennial cohort will have a significant impact in the workforce and the future of healthcare in the United States. They are the largest generational group. Some of the problems facing millennial nurses are the education, training, and development provided to them. Millennials are known to prefer active learning. When Millennials are in lecture based learning they retain less information. They see little value in group activities, but value active learning. The analysis procedure will be described, and millennial nurses’ learning preferences and the relationship to retention will be reported on (Holfer, 2016). Nurses are challenged with an increased number of competencies, therefore requiring new graduate nurses, or nurse residents to apply theoretical concepts into practice. There must be an increase in exposure to clinical training, including interactive lab based learning (Christmas, 2008). The integration of technology into nursing education is equally important. Understanding the Millennial learner positions hospital leadership to create the necessary education, training, and development programs with the millennial learner in mind.
Millennials are natural collaborators. According to Christmas (2008), developing a team focus is among the best practices for working successfully with millennial nurses. Some Millennial nurses may do better with task oriented environments. The approach of giving environment to millennial which are task-oriented helps keep the millennial nurse engaged. This begins at the start of the Nurse Residency. The Nurse Residency in theory offers a continued learning environment for newly licensed registered nurses. The residency allows hospitals to leverage their multi-generational workforce, while providing a thorough education and transition from student nurse to practicing nurse. Nurse Residency programs and the use of interactive learning and mentoring as part of the Millennial Nurse Retention. Interactive learning and mentoring have a strong likelihood of impacting knowledge retention. A recent study showed that first year medical students who engaged in interactive learning while studying cardiovascular physiology had a positive impact on their retention of the material being taught (Hall et al, 2016). Interactive learning for Millennials in the field of nursing is commonly done in a lab setting, providing an opportunity for the Nurse Resident or experienced nurse to practice the skill to better retain the information taught.
“Millennials are continuous learners, team players, collaborators, diverse, optimistic, achievement-oriented, socially conscious and highly educated” (Brack and Kelly, p. 4, 2012). Nurse Residency education or continuing education provided for experienced nurses needs to be presented in a manner that allow the learner to retain the information. According to Jensen (2016), existing residency programs need to be evaluated to ensure proper teaching methodologies are being uses as we see an increase in Millennials entering the nursing workforce. The same can be assumed for continuing education classes. They should be taught in a manner that the audience learns and retains information.
Millennials have been described as a cohort challenged to stay focused on one thing. Researchers suggest they need ongoing interaction and prefer to multi-task (Pardue and Morgan, 2008). When these elements are missing in the workplace Millennials are at risk to flee. They are known as the job hopping generation. Studies have shown that career progression is the top priority for Millennials (Gedeon, 2013). Millennial values and behaviors need to be considered when trying to teach and retain millennial nurses. When a nursing workforce feels valued, and educated in a manner they prefer it will lead to increased job satisfaction and engagement, therefore increasing millennial nurse retention. When this is lacking there is millennial nurse turnover. The national turnover rate for bedside nurses is 17.2 % (NSI, 2016). The bedside is where the majority of nurses begin their career. If they are a Nurse Resident, they are a bedside nurse.
New graduate millennial nurses face many challenges when transitioning into the workforce. Healthcare organizations have an opportunity and responsibility to support the professional growth and development of its staff and focus on retention. This begins with understanding the necessity of adapting to change (Hoff, 2016). The Millennials have penetrated the workforce and have created a need for change to adapt to their needs and values. Research suggests that engaged millennial nurses begins with their training and development (Depsey and Reilly, 2016). Identifying the way they learn and retain information positions the Millennial Nurse Resident for success and increases the probability of retaining them. Nurse Resident’s programs that are based on interactive learning model and mentorship increases their engagement and reduces the turnover (Holfler, 2016). Nurses are the largest provider of care, and with the growing nurse shortage it has caused hospital leadership to spend millions of dollars on recruitment and to replace nurses (NSI, 2016). According to Hoff (2016), Millennial will require healthcare systems to employ a multitude of strategies to engage, teach, train, develop and retain this generation. If effective methods of teaching, training, and developing millennial nurses is not developed you will see a decline in millennial nurse engagement, ultimately leading to an increase in turnover and the shortage. Further research is essential to offer improvement to hospital leadership, nursing education, and nurse managers regarding millennial nurse education and engagement strategies for improved Millennial nurse retention.
Nurses are the largest group of healthcare professionals. According to American Association of Colleges of Nursing (AACN) a survey conducted in 2013 revealed that 55% of the current nursing workforce was over the age of 55. Healthcare and hospital systems are faced with combating the increasing nursing shortage. The national turnover rate for bedside nurses is 17.2 % (NSI, 2016). The bedside is where the majority of nurses begin their career. If they are a Nurse Resident, they are a bedside nurse. There is a financial cost associated with turnover, but more importantly this significantly impacts the patient’s experience. The turnover of a nurse costs a hospital an average of $37,700 to $58,400 (NSI, 2016). The nursing shortage has existed and evolved.
The nursing shortage has plagued the Unite States, especially since the end of World War II. Experts suggest there is a combination of factors that continue to generate the shortage. There is a growing need for nurses, higher acuity, and turnover and retirement continues to increase (Grant, 2016). At the root of the shortage is the amount of nursing school applicants being denied admissions. According to the American Association of Colleges of Nursing, the number of nurses entering the baccalaureate program has increased by 2.6 percent, but this won’t be nearly enough to meet the growing demand. Nursing schools turned away more than 79,659 qualified BSN and graduate applicants in 2012 citing causes such as budget constraints, limited clinical sites, and too few faculty members to handle the quantity of students (AACN, 2014)
The recruitment difficulty index to attract, recruit, and retain experienced nurses has caused the industry to shift focus on the new graduate nurse population (NSI, 2016). Insufficient staffing, increased stress, decreased job satisfaction, and lack of effective training or development opportunities are leading to Millennial Nurse turnover. Specifically, the stress associated with transitioning to a practicing nurse is associated with improper teaching methodologies for the millennial learner. The importance of managing nurse retention continues to grow as we see a steady increase in the nursing shortage. First year nurses have the highest amount of turnover, as much as 29.2% (NSI, 2016). The turnover is related to the residency or on-boarding. One of the largest contributors to Millennial Nurse turnover is the teaching methodologies used to develop them and their level of engagement. The root of this problem begins during nursing school and only heightens as millennial transition to practicing nurses or nurse residents.
A recent study conducted by the Mayo clinic examined millennial medical education; encompassing different varieties of specialties and practice. The study examined competency based and assessment driven education. “The milestone-based assessment provides a sense of mentorship to students by continuously following them down a spectrum and evaluating their performance,” says Dr. Reed. “This assessment allows the individuals providing feedback to be very specific and tailor that feedback to millennial learners in a way that is pertinent to the skill set they’ll need in their medical profession (Desy, 2017)”. Millennial nurse residents and practicing nurses prefer instant feedback and interactive learning opportunities. Traditional teaching methods cause them to become disengaged and are ineffective; often the millennial learner does not retain the information being taught (Eckleberry-Hunt and Tucciarone, 2011). Nursing turnover continues to increase each year; with first year nurses or nurse residents seeing the highest turnover, likely due to the teaching methodologies being used to train and develop them. Improving Millennial Nurse Retention is necessary for patient experience and hospital performance.
Purpose of the propose study
The purpose of this study is to understand the impact teaching methodologies have on millennial nurse retention. Millennials have different values and expectations then other generational cohorts. They learn differently than the generations before them. To retain millennial nurses healthcare organizations must keep them engaged and provide them with an appropriate learning environment, while delivering the education in a manner they can learn. Providing a Millennial focused learning environment positions healthcare systems see their nurse residents succeed in their residency and apply what they learn directly to the care provided to the patients. In theory this would lead to increased job satisfaction, engagement, and higher retention with the millennial nurse cohort. The intended result is to take the findings and develop a retention plan focused on the millennial cohort values, and adapt new methods to their learning preferences. Traditional teaching methods are less effective on Millennials. Implementing technology into nurse residency and development will require support from stakeholders (McLeod, 2008). Technology and interactive learning have a strong probability of increasing teaching effectiveness and success of the nurse. This would have a positive impact on the patients’ experience and decrease the nursing turnover or shortage.
What impact will the preferred millennial teaching methodologies will have on the Millennial Nurse Retention at Magnet Status teaching hospital?
How this study will effect millennial nurses’ learning preferences and the themes as it relates to Millennial nurse retention?
How accurately visible will be the foundational understandings of the experiences and perception of Millennial nurses going through the nurse residency?
The conceptual framework will be for a qualitative study. The aim of this study is to understand how teaching methodologies impact Millennial Nurse retention and provide nurse educators and hospital leadership with guidance for increasing millennial nurse retention. As the nurse shortage continues, it is critical to understand millennials’ characteristics, motivation, needs, and what contributes to their retention. An extensive search of printed material has been conducted with the intention of developing an understanding of the evolution of millennial in healthcare and the approaches necessary to train and develop them, revealing the themes on how they learn and develop. A print-based approach serves as the foundation for the literature used in the initial research and was achieved by accessing materials available in libraries, commonly scholarly articles, with secondary sources being printed books. These proved limited and so the search of academic databases was expanded to include millennial in other fields outside of healthcare.
New Graduate nurses are the primary pipeline of caregivers for acute hospitals (Goode et al, 2009). They face many challenges as they transition into the workforce. One of the most impactful challenges is training and limited access to mentors (Holfer, 2016). The generational diversity of the nursing workforce makes it challenging to orient new graduate nurses and provide them with the type of education and mentoring that meets their needs. For Millennial nurses’ coaches or mentoring is fundamental to their transition from student nurse to practicing nurse (Holfer, 2016). The Nurse Residency program as a means for educating and orienting New Graduate nurses is said to be critical to their success in an acute setting (Goode et al, 2009). The teaching methodology used to educate the nurses during orientation is
Active learning as a means for educating and developing millennial nurses is an emerging trend targeted at millennial retention. Teaching hospitals have moved towards nurse residency programs to assist with the transition from student nurse to professional nurse (Goode et al, 2009). The programs have evolved to be focused on the learning needs of the millennial. While studying active learning an examination of adult learning theories rooted in Mezirow’s transformational learning theories provides the necessary foundational understanding of adult learning practices allowing for a thorough understanding of the changes to adult learning as it pertains to millennial.
The ‘Digital Native’ discourse emerged in the late 1990s and has its origin in the work of Tapscott (1998, 2009) and Prensky (2001a, 2001b). Until recently the notion that there is a generation of learners with distinct skills and characteristic attributable to the exposure to digital technology had been accepted uncritically by many educators. Despite the considerable attention focused on ‘Digital Natives’, remarkably few studies carefully investigated the characteristics of this group. Moreover, the concept emerged from developed world contexts (primarily the US and Canada but also Australia, the United Kingdom and Japan). We know little about how relevant this is in developing world contexts where access to advanced technology is limited (Malhotra, Ahouilihoua, Eshmambetova, Kirungi, et al., 2008). Millennial are commonly referred to as digital natives. In addition to active learning the desire for web-based learning, also referred to as e-learning was examined. When considering healthcare, specifically nursing it is important to recognize that continuing education is a requirement at the majority of magnet status hospitals. While traditional classroom lecture methods are still utilized they are becoming the secondary means for educating and developing millennial nurses and healthcare professionals.
This study also examines causes of turnover and retention. Teaching the Millennial learner has been a popular research topic over the last decade, with the majority of the research focused on traditional learning environments, as opposed to adult or corporate learning. Existing research has experimented with customized learning for millennial; only in recent years has this correlation been tied to retention of millennial in the work place. Millennial are accustomed to sophisticated technology; it can be inferred that the desire to stay with an organization is rooted in whether or not their values or what motivates them is addressed.
Nature and Significance of the Study
The purpose of this qualitative study is to examine millennial nurses’ learning preferences and the themes as it relates to Millennial nurse retention. The study seeks to provide a foundational understanding of the experiences and perception of Millennial nurses going through the nurse residency. Additionally, we seek to understand the perception of practicing millennial nurse as it pertains to engagement, feedback, training and development provided to them. Generational theorist suggests that Millennial are techno literate, meaning they are technologically fluent and dependent on technology. This dependency impacts the way they learn and retain information. Millennial like teamwork, collaboration, and prefer to work with their generational peers; these components are critical to their success in a Nurse Residency or as a practicing nurse (Skiba, 2006).
To address the issue of nurse retention we must understand existing themes between learning preferences, adult learning theories, identify what motivates nurses to stay, and how they wish to learn and develop. Developing an understanding of Millennial needs will allow a magnet status hospital to develop the necessary retention strategies and education programs; while being sensitive to the fact that we still have a multi-generational workforce. As Active learning and web-based learning continues to grow in popularity for corporate training and development, nurse educators are charged with the responsibility of creating effective training and development programs that utilize traditional methods in addition to the methods that successfully teach the millennial nurse; otherwise the risk for turnover will not only exist but likely rise, and with the growing nurse shortage this will negatively impact patient care and hospital operations.
The current nursing shortage is due to the aging population and generational divide in the workforce. Hospitals are seeing an increase in retirement. Nurse educators and hospital leadership face many challenges with the millennial cohort. According to Grant (2016), America’s 3 million nurses make up the largest segment of the health-care workforce in the U.S., and nursing is currently one of the fastest-growing occupations in the country. Understanding the characteristics of millennial nurses allows hospital leadership and nurse educators to understand their learning preferences. The practice of utilizing a nurse residency program to help new graduate nurses transition to clinical practice is still relatively new. Today approximately 50% of all new graduates leave nursing within two years of graduating (AACN, 2011). According to Long (2016), the new norm for Millennial is four jobs in the first ten years out of college; a slight improvement from previous statistics.
The majority of existing research on millennial retention is not specific to nurses. The use of interviews with millennial nurse residents and practicing nurses will allow an in-depth look at their perception of the teaching methodologies used in their nurse residency. Existing research explores generational theories, characteristics and values of Millennial, and learning preferences. To understand the experiences of millennial nurses, one also needs a firsthand accounts. This will allow an understanding of their perception to be developed, as well as themes regarding millennial nurse retention.
This study will bridge the gap with existing research and literature on millennial nurse retention because of the identified themes for Millennial learning preferences. A correlation between engagement, millennial characteristics, values, and learning preferences will be identified. The study results will help identify retention predictors related to how millennial nurses learn verses how they are being taught and developed. A targeted focus group will allow research specific to existing residency programs to be completed, also allowing for an understanding of the challenges faced by nurse educators because of the generational divide and the impact this has on retention.
Millennial, Nurse Retention, Magnet hospital, communication, active learning, Nursing Education