The literature review supports the purpose of this study, which is to determine the impact teaching methodologies, training, development, and engagement have on Millennial Nurse retention. The purpose of this literature review is to examine the different research about nurse retention and the teaching methodologies that are present and can be applied to the new nurses in order for organizations to better retain their nurses, specifically the millennial generation. The review will also include a critical review of the literature and the methodology used in the existing literature. This will provide a perspective of the kind of literature currently used. Through the literature review, concepts including millennial, Generational theories, adult learning theories, and retention and teaching methodologies that are best suited for millennial nurses will be examined.
The initial section of the literature review provides an overview of millennial and then discusses primary research that is the foundation of this study. The literature review progresses to included adult learning theories, Active Learning and Educating millennial, and
Millennial Nurses learning preferences. The purpose of establishing a foundational understanding of the millennial cohort is to understand how adult learning theories apply and support existing research indicative of Millennial nurse learning preferences, and the impact this has on retention at Magnet status hospitals.
The conceptual framework explains the different views that are found in and which guide the research. The main themes that will be explained in the literature review are as follows:
- Transformational learning and Adult Teaching theories
- Teaching methodologies that are best suited for millennial
- How teaching methodologies impact Millennial Nurse retention
In the first theme, the review will look at the nature of millennial and the generational theories of how those who are in this generational cohort prefer a different style of teaching that better supports how they learn and how millennial have come to prefer a different environment in their work areas in relation to the nurses. The second theme looks transformational learning and the different adult teaching methodologies and theories that can be applied in the classrooms in order to enhance millennial education and later enhance their retention in their professional areas, specifically nursing. The third theme looks at the manner in which these teaching methodologies affect the retention of Millennial nurses. Finally, the review will look at how the teaching methodologies impact millennial nurse retention.
Millennial according to Hendricks and Cope (2013), are defined as individuals that are born between 1980 and 2000. According to Hendricks and Cope, millennial may also be known as echo boomers because they are the children of baby boomers, or someone who was born during the period of increased birth rates that occurred between 1946 and 1964. The millennial represent a unique generation, different from any other. The Millennial generation, also commonly referred to as generation Y is the digital generation. The millennial are people who have grown up with the World Wide Web and instant access to information. Digital technologies are engrained in their daily activities of living. The use of instant messaging, emailing, cellular devices, tablets, and video games has caused communication to evolve and change; today it is less personal and more digital, changing the manner in which millennial learn, find information, communicate, and function (Cosidine et al, 2009). The Millennial generation is vastly different, and has significantly impacted areas such as education, employee development and training, and the exchange of information.
Growing up with modern technology, this generation is highly skilled in the digital world. Haugen and Musser (2013) state that generation Y strive to succeed and have a need and demand for professional development and career growth. The authors show that, combining all these factors is indicative of an exciting new work force. The millennial generation, those born between 1980 and 2000 is now entering employment in vast numbers, and they will shape the world of work for years to come. Attracting and retaining the best of these millennial workers is critical to the future of any kind of business, especially health care (Howe and Strauss, 2000). The career aspirations of millennial, their attitudes about work, and their knowledge of new technologies will define the culture of the 21st century workplace.
According to Johanson et al (2012), because millennial are technology savvy and reliant on technology, their behaviors in the classroom has been different from the previous generation and this has caused educators to introduce teaching methodologies that suit their needs and preferences. As Haugen and Musser (2013) explain, Millennials’ use of technology clearly sets them apart. One of the defining characteristics of the millennial generation is their affinity with the digital world. They have grown up with broadband, smart phones, laptops and social media being the norm and expect instant access to information.
The Millennial generation continues to increase in the United States workforce, largely due to immigration. Today there are more than 75.4 millennial working, making them the largest generation in the workforce today (Fry, 2016). As this number continues to increase; the need to understand the millennial worker, what motivates, them how they learn, and what will retain them becomes exponentially more important. According to Murphy (2012), retaining millennial gives organizations a competitive edge. This is the first generation to enter the workplace with a better grasp of technology and key business tools. This leads to a different set of employees; this is true also in nursing. Organizations have to evolve themselves in order for them to accommodate the needs of the millennial employees. Millennials’ needs and values matter because they are not only different from generational cohorts before them; they are also more numerous than any other generational cohort still in the workforce. Millennial already form 25% of the workforce in the US. By 2020, millennial will form 50% of the global workforce (Haugen & Musser, 2013). The millennial generation requires different retention strategies then previous generations.
Millennial workers voluntarily leave organizations in a short period of time. Some theories suggest this is due to boredom; the methods utilized for employee development and education, or lack of stimulation or motivation. This is especially true in industries such as healthcare. This is largely in part due to accessibility of new jobs. The cutting edge technology and use of information technology communication has created an environment that is challenging to comprehend. The reliance on information technology communication has created a false sense of competency in many cases.
This is impactful when you consider the necessity for employee development and continuing education. According to Lebowitz (2016), the results of the Global Millennial survey revealed that 63% of millennial said they left their employer because their leadership skills were not being developed. In healthcare there is consistent innovation, therefore requiring the caregivers to be engaged, informed, and educated. The millennial healthcare worker has different standards, expectations, and is motivated differently. Their behavior is impacted by their experience of the global economic crisis. Millennial cohorts places much stronger emphasis on their personal needs than on those of the organization. Because of this, employers, including hospitals should be cautious. Millennials tend to be uncomfortable with rigid corporate structures and become disengaged by information silos.
They expect hasty succession, and constant feedback in the work they do (Johanson et al, 2012). Most of Millennial nurses do not receive the feedback or acknowledgement they need. This has led to 23% of nurses in the United States leaving their jobs citing dissatisfaction with the working environment according to the study by Price (2014). This is why the retention of millennial nurses is becoming an issue in. Millennial are constantly seeking new opportunities and they don’t believe that their current place of employment aligns with their ideals, therefore, the issue of Millennial workers’ behavior and expectations in the workplace causes organizations to have a difficult time in retaining them (Haugen & Musser, 2013).
Millennials are the first generation in the workforce that has been immersed in technology their entire lives. Computers, the internet, digital forms of communication, learning activities, and immediate access have been part of their home, school, and work lives. There has never been a time they have been without technology. This has created an entire new language and culture, which has poured into the workforce in nearly all industries; requiring a change in how employees evolve. The digital natives have a limitless interest and curiosity in technology (Cosdine et al 2009). Millennials are highly engaged in technology and the use of informational technologies; this suggests that when teaching or developing a millennial the use of technology to do so should be included. This is critical in the workforce, especially in industries such as healthcare. This is a critical aspect to educating, developing, and retaining millennial nurses.
Millennials have very specific characteristics. They are impacted significantly by economic, political, and social backgrounds (The Millennial Generation, n.a.). According to Howe and Strauss (2000), the millennial generation is the next “Greatest Generation” (Strauss and Howe, 1997, pp. 119-121). They are the multitasking generation. They are continuous communicators. This translates well into the workforce, and is critical in fields such as healthcare, specifically nursing. This establishes virtual real-time relationships in both social, educational, and work related endeavors (Dannar, 2013). The ability to multi task can increase productivity, but one must not lose sight of the millennial needs for balance. There is no compartmentalizing; millennial draw correlations from all aspects of daily living. Millennial have an innate power to influence society, and specifically organizations.
The immergence and reliance on social media, digital communication, and media is specific to Millennial. The ease at which information is exchanged, and the need for interactive nontraditional methods of communication, teaching, and development stems from millennial influence. As an example, according to Dannar (2013), Millennial seek to create content, be engaged in active learning, and have specific values that translate to the work place. These values influence behaviors that create norms and patters that are distinctly millennial. There have been studies that examine generational learning styles and preferences. Some are indicative of transformational learning because millennial sense of reality is different than generations before. One should note that a thorough understanding of adult and transformational learning and the millennial generation leads to an understanding of best practices for employee training and development and learning preferences for millennial nurses and healthcare workers.
Adult Learning Theories
Adult learning pioneer (Malcolm Knowles, 1973) illustrates that the idea of adult learning theories have various assumptions. The theory created for the adult learning theory was andragogy. Some of the assumptions of the adult learner include that adult learners move from dependency to increasing self-directedness as he or she matures and can direct his/her own learning (Mangold, 2013). Another assumption is that the theory of andragogy draws on the learners accumulated reservoir of life experiences to aid learning. The adult learner is assumed ready to learn when they assume new social or life roles (Subhan, 2014). The adult leaner is also assumed to be problem-centered and they want to apply their new learning immediately. An assumption of the learner is that they are motivated to learn by internal, rather than external, factors; meaning that they are willing to learn and the drive to learn comes from them and not from external incentives (Robb, 2014).
Based on the theory, there are implications for practice for educators of the millennial cohort. Mangold (2013), suggests that adult educators need to set a cooperative climate for learning in the classroom; including corporate or clinical. This means that the educator needs to create an environment that has all the resources necessary for the millennial student to learn. Robb (2014), in his literary work shows that an educator assesses the learner’s specific needs and interests. Mangold (2013), continues to show that in teaching adult learners, they need to develop learning objectives based on the learner’s needs, interests, and skill levels. Johanson et al (2012) explains that the educator needs to design sequential activities to achieve the objectives. Works (2016), in his research work shows that adult learners need to work collaboratively with the learner to select methods, materials, and resources for instruction. Johanson et al (2012) adds that educators based on the adult learning need to evaluate the quality of the learning experience and make adjustments, as needed, while assessing needs for further learning.
Mangold (2013) concludes in his works that adults learn by doing, effective instruction focuses on tasks that adults can perform, rather than on memorization of content. Because adults are problem-solvers and learn best when the subject is of immediate use, effective instruction involves the learner in solving real-life problems.
Transformational and Adult Learning
Transformative learning is an adult learning theory that challenges the formative learning one experience throughout their childhood. An individual’s perceptions are derived from experiences that occurred throughout their childhood. Formative learning occurs through exposure socially and scholastically. The millennial generation relies on the use of technology in social and scholastic settings. This is true in the workplace, and is increasingly true for nurses and other healthcare workers. The presuppositions and assumptions one has as an adult are formulated by informal learning tactics; exposure from parents, friends, mentors, culture, religion, school, and the workforce. Additionally, the millennial generation is influenced by technology, social media, and information communication technology. These learning experiences define an individual’s perception of truth. “Transformative theory views memory as an inherent function of perception and cognition, an active process of recognizing again and reinterpreting a previously learned experience in a new context” (Mezirow, 1991, P. 6). Mezirow believes that adult learning occurs in four ways: elaborating existing frames of reference, learning frames of reference, transforming points of views and transforming habits of mind (Brookfield, 2009). Transformative learning causes individuals to challenge their “reality”, therefore either validating their assumptions or disproving them. This is especially true in adult learning and development in the workplace.
Adult’s conscious ability to rationalize and actively reconstruct their beliefs and behaviors is rooted in learning. Learning is continuous experience. Learning involves five primary interacting contexts. The interacting contexts include the meaning perspective, condition of communication, action in which learning occurs, self-image and the situation that is encountered (Mezirow, 1991, P. 13-14). Studies indicate the millennial learner have significantly influenced education in both corporate and higher education settings. Specifically at teaching hospitals there has been an exponential increase in the use of interactive learning. Millennial have caused hospitals, corporations, and educational institutions to both communicate and educate in new and innovative ways (Kriegel, 2013). Some studies suggest millennial learning and transformational learning will create innovate educational initiatives that are impactful throughout society.
Transformational teaching approaches are essential for the millennial learner. According to Boyd (2009), Transformational teachers help their students see the larger view of education by practicing idealized influence. The uses of intellectual stimulation in the classroom help students challenge their existing assumptions (2009). This is important when teaching and developing a nurse. Millennial nurses learn and advance their skills best through active learning. Educators who provide their students with opposing views, theories, or methods allow for developmental growth and learning. This is true in professional development or classroom learning. This practice leads to a highly engaged cohort (Boyd, 2009). Similar to other generations, millennial adult learners also have two learning domains that are essential to learning and having the ability to think autonomously; they are instrumental learning and communicative learning. The two learning domains apply specific concepts that affect the process of learning.
Theories suggest this is increasingly important for the millennial worker, because there is ongoing learning and education in the workplace. To understand the manner in which the two domains impact learning for millennial you must first have a clear definition of learning. Learning can be defined as “the process of using a prior interpretation to construe a new or revised interpretation of meaning of one’s experience in order to guide future action” (Mezirow, 1991, P. 12). This is an important factor as you examine the two domains of learning because they both impact the adult learners’ ability to understand the meaning of experiences and formulate new frames of reference. In healthcare and the practice of nursing it is suggested that the instructor develop relationships with their students (Boyd, 2009). This is a critical component to the manner in which millennial learn and the importance of the two domains of learning.
Instrumental learning is the development of determining the cause and effect relationship. Dannar (2013) suggests the theory that millennial thrive best in a mentoring environment. “Millennial have an inherent trust in organizations and a strong preference for the structures and systems that support them” (Dannar, p. 6, 2013). This aligns with many theories that indicate an adult leaner is engaged through task oriented problem solving and relationships. Through the exercise of engaging in instrumental learning the adult is able to fundamentally determine meaning. This is of critical importance to millennial, and commonly those in the field of nursing. Studies suggest that this aligns millennial need for personal growth, development, and relationship (Dannar, 2013).
Instrumental learning begins with the simplest task of developing a prediction. This commonly pertains to how to make something better by doing something different. Once you have determined your prediction or hypothesis you as the learner begin to test the hypothesis by using different variables that may affect the outcome. This is important to millennial nurses and healthcare workers because they want to impact the patients’ experience, and expand their knowledge base and practices. According to Mezirow, instrumental learning always involves a prediction. “ A proposition can be established as “valid”-that is, justified or supportable-by demonstrating its empirical “truth”, that is, it’s being in accord with what is, and correctness of the analyses involved” (Mezirow, 1991, P. 74). This experimentation develops critical thinking skills and is hands on learning experience, both critical elements of being a nurse.
Critical thinking in instrumental learning is what makes the learning task oriented. When engaging in instrumental learning the learner is questioning procedures, experimenting with variables and collecting data. This process accomplishes the task of finding alternative ways of completing the same task or generating an improved way of doing something, often an important variable to the millennial worker. Millennial place a high value on communication. The second learning domain that is essential to learning is communicative. Communicative learning is centered on learning to understand what others mean and how to make ourselves understood and the ideas we share (Mezirow, 1991, P.75). Theories suggest that many millennial learn more in the second domain.
This is especially true in nursing According to many transformational learning theorists this is the most significant learning for an adult. This is because it involves understanding, describing and explaining a range of elements that impact one’s ability to communicate effectively (Mezirow, 1991, P. 75). The elements that impact our ability to communicate are driven by cultural, linguistic and social norms. Communicative learning is the act of at least two people trying to reach an understanding of the meaning of an interpretation or belief (Mezirow, 1997). Millennial thrive on constant communication.
This is a large contributor to retaining the millennial healthcare worker. Their level of engagement, relationships, communication, and active learning impact their level of satisfaction. Through transformational learning an adult can formulate their own individual concepts, values, feelings and frames of reference which create the ability for one to think autonomously, a critical skill in nursing. Transformative learning assists adults in creating an understanding of meaning, generating their own ideas and the ability to make decisions. Millennial nurses have an increased level of responsibility and decision making in teaching hospitals; they are an essential member of the care team. Studies suggest that the evolution of nursing as a practice has experienced the most significant change with the millennial cohort. Studies suggest the key to developing and retaining millennial is understanding their learning preferences.
Adult Learning Theories
In the creation of learning theories, Knowles who as a pioneer of the phenomenon showed that the idea of adult learning theories has various assumptions. The theory created for the adult learning theory was andragogy. Some of the assumptions of the adult learner are that adult learners move from dependency to increasing self-directedness as he or she matures and can direct his/her own learning (Mangold, 2013). Another assumption is that the theory of andragogy draws on his or her accumulated reservoir of life experiences to aid learning. The adult learner is assumed ready to learn when they assume new social or life roles (Subhan, 2014). The adult leaner is also assumed to be problem-centered and wants to apply new learning immediately and an assumption of the learner is that they are motivated to learn by internal, rather than external, factors (Robb, 2014). Meaning that they are willing to learn and the drive to learn comes from them and not from external incentives.
Based on the theory, there are implications for practice for educators of the millennial cohort. Mangold (2013) suggests that adult educators need to set a cooperative climate for learning in the classroom. This means that the educator needs to create an environment that has all the resources necessary for the student to learn. Robb (2014) in his literary work shows that an educator assesses the learner’s specific needs and interests. Mangold (2013) continues to show that in teaching adult learners, they need to develop learning objectives based on the learner’s needs, interests, and skill levels, (Johanson, 2012) explains that the educator needs to design sequential activities to achieve the objectives. Works (2016) in his research work shows that adult learners need to work collaboratively with the learner to select methods, materials, and resources for instruction. Johanson et al (2012) adds that educators based on the adult educators learning need to evaluate the quality of the learning experience and make adjustments, as needed, while assessing needs for further learning. Mangold (2013) concludes in his works that adults learn by doing, effective instruction focuses on tasks that adults can perform, rather than on memorization of content. Because adults are problem-solvers and learn best when the subject is of immediate use, effective instruction involves the learner in solving real-life problems.
Active Learning and Educating Millennial
Teaching millennial has been an increasingly popular subject for research. Researchers have theorized about customizable learning, interactive learning, and learning through gaming, flipped classrooms, and e-learning as methods that best address the needs of millennial learners. Millennial are non-traditional students. This is true in both higher education and corporate settings. The use of online learning really began to significantly increase in 1993 when Jones International University became the first fully online university accredited by the Higher Learning Commission. Over the next decade higher education would see smaller colleges and universities, as well as for profit institutions create more innovative, and student focused learning opportunities that can be delivered online.
Corporations and hospitals soon followed the example and began offering requiting continuing education classes online, classes that lead to career growth such as introduction to project management, or misc. health care related classes applicable to clinical settings, and a multitude of other subjects. This practice was appealing to nontraditional students, as it provided a pathway to continued development. From a higher education perspective; curriculum for the 21st century student needs to deliverable online to create optimal persistence and retention rates, and be engaging and project based, addressing real world problems, and issues important to their field of study (Marx, 2006). This penetrated the millennial nurses; as of 2014 55% of the nurses held a Bachelors of Science in Nursing. This is expected to increase to approximately 80% by 2020 (American Nurses Association, 2014). Today, registered nurses can complete the Bachelors of Science of Nursing through distance education. This translates into how they wish to learn, train and develop as a nurse.
Today’s students expect digital access to their courses, just as they can email a professor they expect to have their lecture notes online, books available digitally, and many expect their courses and degrees to be offered completely online. A recent study survey 57 millennial student nurses and indicated they were reliant on technology, and they learn and retain information through active learning and technology (Montenery et al 2013). The study was indicative of the need of nursing education to use technology and modernize their method of delivery. A similar survey indicated similar results for a cohort of nurse residents at a teaching hospital. Millennial learners see little value in group work and prefer technology be integrated into teaching methodologies. Classes with active learning will have a higher learning outcomes; this is true at academic institutions and hospitals (Barnes and Jacobson, 2015).
“ Many distance-based courses allow student to use several learning modules, such as online message boards, chat rooms, video conferences and recordings of lectures, making distance learning a highly customizable educational option”(Thompson, 4p, n.d.). In 2010 a study was conducted with individuals who coined themselves digital natives, and it revealed that millennial students need a different type of faculty approach. By this we refer to the type faculty an academic or corporate education setting. Specifically the findings are indicative of the need to select faculty that can incorporate technology, guide their students and be empathetic to their different ways millennial learn (Black, 2010). Nursing education at teaching hospitals utilize faculty to orient nurses. Orienting millennial nurses can prove to be challenging. A structured orientation can facilitate the transition from new graduate to professional nurse and assist in the retention of qualified nurses and ultimately safe patient care (Riegel, 2013). The nurses in this study were born between the years 1980-1989, and graduated from a nursing program within three years of the study. They were employed in acute care and had started or had recently finished their orientation process within the clinical setting. The results of this study are indicative of the need to modernize nursing orientation and continuing education classes.
Millennia’s are used to living in a multi-media culture. A study conducted in 2008 examined 19 different instructional designs, and the increase in millennial nurse retention in nurse residency programs. The success was more common in magnet status hospitals, commonly referred to as teaching hospitals. Increased use of instructional technology integration strategies in nursing orientation programs resulted in an increased retention of new nurses. The results stem from a survey of 161 nurses residents (Hancharik, 2008). Another recent trend is the emergence of social media support groups. This important for interaction and professional growth for millennial nurses. This has high probability of a positive impact on learning outcomes and retention. There is an ability to connect in real time and build professional communities and networks. This is advantageous for professional development and employment opportunities, something millennial place high value in and is critical to nurses and other millennial healthcare workers (Skiba, 2008). Millennial nurses rely heavily on digital communication for education, development, and growth.
The chapter discusses how to retain millennial workforce and how important it is for organizations and institutes. I will also be discussing adult theory and the relationship with teaching methodologies and development. The purpose of this study is to develop an understanding of millennial nurse retention trends and recommend best practices and changes that have a high probability of increasing retention. How critical thinking plays a role in instrumental learning which is preferred by millennial as it is task oriented. The millennial tend to communicate differently as they are bred in digital and multimedia world and therefore don’t prefer leaders who manage them. The use of active learning and the ability to connect in real time and make professional communities. Another recent trend is the emergence of social media support groups. This important for interaction and professional growth for millennial nurses. This has high probability of a positive impact on learning outcomes and retention.