Chapter 3: Methodology
This study will be based on the relationship between adult learning theories, engagement, and retention, with a particular focus on Millennial Nurses at Magnet status hospitals. The importance of education for healthcare professionals is immeasurable. The turnover rate at a hospital impacts has a high probability of negatively impacting patient experience and care, due to the high nurse-to-patient ratio. A startling retention statistic indicated that approximately 34% of professionals age 25 and older would leave their employer within 16 months and more recently 36% of the Millennials currently in the workplace will look for a different job at a different organization within 12 months (Adkins, 2016). When employing millennials, it is essential we recognize that they learn, develop and retain information differently, and this is a large contributor to their success or the ability of an organization to maintain them. Education, development, and engagement are directly related to the job (career) satisfaction of members of the Millennial cohort. As an example, millennials need regular feedback as part of their development (Gilbert, 2011).
Providing these elements in the workplace for millennials is of critical importance when considering the ongoing nurse shortage plaguing the United States. The literature review revealed a pattern suggesting that Millennials learn best in an interactive environment, and need development opportunities to remain engaged, with the assumed result of increasing retention results. The literature revealed the related themes with Millennial values; teaching, development, and retaining nurses (Holfer, 2016). Finally, the research also showed the Millennial need for balance and the direct impact this had to keep Millennial Nurses or healthcare providers. These correlating factors and their relationship to Millennial nurse retention are cause for research, to develop an understanding, as well as a conservation strategy targeting Millennial nurses at Magnet hospitals.
The methods described in this chapter are complementary to existing research. The approach is phenomenological. The purpose of the study is to determine and understand if there is a correlation between teaching, developing, and engaging millennial nurses and retaining them at magnet hospitals. The phenomenological study involves several nurses in the Millennial cohort in interviews. 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. Additionally, the study will examine the direct impact teaching methodologies, and development opportunities have on millennial nurse engagement and retention.
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. Specifically, the research will examine Nurse Residency programs and the use of interactive learning and mentoring as part of the Millennial Nurse Retention. Interactive learning and mentoring have a high 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 retain the information better taught.
This chapter will explain the purpose of this research study and the instrumentation that will be used to collect new data to answer the intended research questions. The procedures used to conduct the research will be discussed, as will the limitations, and the anticipated results. The ethical concerns surrounding this study will be examined. Lastly, I will consider the limitations of this study.
The goal of this study is to develop an understanding of the impact teaching methodologies, engagement, and leadership has on Millennial Nurse Retention. The intended result is to take the findings and develop a conservation plan focused on the Millennial cohort values and adapt 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 high probability of increasing teaching effectiveness and success of the nurse. The more hands-on learning a nurse has, the easier the transition to a practicing nurse. As an example, nurses who are educated through interactive learning in a simulation lab have more experience doing things such as IVs (Kim et al., 2016). Post research, I will describe Millennial Nurse Residency teaching, development, engagement, and how leadership can increase retention. Representing nursing educators and hospital administration’s perception concerning the issues and retention efforts will allow necessary changes to be made.
The study will be completed in phases. The steps include the start of a residency and post-residency. To achieve this, two interviews will be conducted with the participants. The study will include new nurse residents and practicing nurses. The rationale is to understand the effectiveness of the Nurse Residency program for orienting new graduate nurses as they transition into practicing nurses. Additionally, by also studying practicing Millennial nurses, we can understand the effectiveness of nurse development and the impact on retention. The instructional technology or methods used to educate nurses impact the maintenance throughout the Nurse Residency program (Hancharik, 2008). The motivation to examine both classifications is to ensure a thorough understanding of the impact teaching methodologies has on Millennial Nurse retention. Nurse Residencies are commonly one year in length, with the first twelve weeks being the most critical. The second concern with retention is continued education and development provided to nurses. Understanding the methodologies in both teaching scenarios exponentially increases the potential success to increase retention. Determining methods of engaging and orienting nurses before they orient on the unit leads to higher nurse satisfaction (Lott, 2006). Finally, an examination of the impact leadership and morals have on Millennial Nurse Retention will be conducted throughout the interview process. This will be done by using a particular question set and coding any changes in attitude identified throughout the interviews.
Some existing data suggest there is a direct relationship between nursing schools and Nurse Residents. There is a vast difference in the content taught to nursing students and nurse residents. The teaching methodologies use, and learning preferences indicate that the nursing education received is a contributor to nursing residency retention (Anderson et, 2012). To better formulate an understanding, interviews will be conducted at the start of the residency and the end of the residency. Participants who are Millennial practicing nurses will be interviewed to understand their perception of nurse development, ongoing education, and the impact on Millennial Nurse Retention. The participants will meet a particular criterion that has been predetermined. Millennials were born between 1980 and 2000 (Dannar, 2013). The measure for this study includes being born between 1982 and 1996, working for a magnet status hospital, and currently in a Nurse Residency program or completed one within the last 24 months, or having been a practicing nurse for a minimum of 5 years and now working in a magnet status hospital. Throughout this phase, I will conduct two (considering three) interviews with participants to learn how they feel throughout their residency or post-residency as they begin to practice nursing on their own.
Follow-up check-ins will be conducted once a month with interview participants to determine if any change in attitudes or morals. The use of open-ended questions will be utilized. This will be done over a period of 16-32 weeks, with the interviews occurring 12-16 weeks apart. Nurses will be interviewed twice. The field of nursing has ongoing education. The periodic check-ins will allow for data to be collected from Nurse Residents and practicing nurses examining the teaching methodologies, retention, or change in attitude among the sample group. The ongoing change will be considered when analyzing interview results.
At the conclusion of the meetings, I will determine from the data if nurses elected to resign from their residency or post-residency positions. The final interview will ask interview participants about staffing changes in their unit to determine if there was any turnover. Interviewees who resign from their residency or post-resident position will be considered when discussing retention and turnover. This group will be from the original sample group that started a nurse residency program or completed one within the last twenty-four months. The purpose behind the follow-up is to understand better what caused them to resign and seek employment elsewhere. The intended goal is to use the data to formulate recommended best practices to limit resignations and increase Millennial Nurse Retention.
Research and Related Questions
How do teaching methodologies and the way Millennials learn affect Millennial Nurse Retention at Magnet Status teaching hospitals?
- What type of teaching methodologies is currently being used during orientation?
- What teaching methods are currently used during new graduate nurse residency?
- What teaching methodologies are used in career development or continuing education classes?
- What are the preferred teaching methods selected by Millennial Nurses and Nurse Residents?
What is the impact leadership has on Millennial Nurse education and retention at a statute teaching hospital?
- Does leadership accessibility contribute to the education being received by Millennial nurses?
- Does leadership accessibility impact the morale and retention of Millennial nurses?
- Does leadership style play a role?
- Does giving Millennial nurses the opportunity to take a leadership role in developing their peers impact the education being provided and the retention results?
What role do good and engagement play in Millennial Nurse retention?
- Is morality linked to education being provided?
- Is morality related to the Millennial nurse’s ability to retain the education being provided?
Is there a correlation between morale, leadership, education, and Millennial Nurse Retention at Magnet Status Hospitals?
- Did the attitude of Millennial nurses change throughout the residency?
- Is this linked to teaching methodologies and leadership?
The Data collected used for this study will be through interviews. The interview method allows for investigation into the experiences and perceptions of Millennial nurses. The meetings will be structured and follow existing discussion guides. A consistent set of questions will be used. The investigation will be centered on describing the experiences of the sample population (Polkinghorne, 1989). Phenomenological studies provide the perspective of the participants. Creditability in this instance will be assumed because it is the interviewee’s perceptions. I will use active listening while encouraging participants to disclose their experiences and feelings fully. After completing the interviews, I will go through the process of reflection. The thought process will serve as an opportunity to develop an understanding of the perception being shared. The interviews will be recorded to allow for deeper reflection.
The initial interview will be used to confirm the participant meets the necessary criterion. The questions that will be utilized in the preliminary meeting will determine whether members were born in the years 1980-1996, and are currently nurse residents or experienced nurses at a Magnet Hospital. The rest of the questions will be open-ended. The first formal interview will be scheduled at that time. The discussion will cover the topic of teaching methodologies used, and what they believe would be more efficient. The participant’s perspectives on education and retention will be discussed, trends they have seen, and their opinions. The interview will also cover leadership’s role and morals. A second formal meeting will be set up at that time. There will be additional follow-up interviews conducted to check in and determine if attitudes have changed.
In this study, Millennial Nurses are identified as individuals born between the years 1982-1996. The Millennial cohort spans a larger group, but for the purpose of this study, the focus will be on this age group from the cohort. The potential participant pool will be drawn from private advertisements through nursing school alumni associations, professional networking such as LinkedIn, or vocational nurse organizations. Participants in the study will be working at Magnet status hospitals. A large concentration of the population resides in the greater Cleveland area. The study will be conducted over a span of 16-26 weeks. A minimum of two interviews and a maximum of four will be held with participants.
Respondents to the advertisements will be local in the greater Cleveland, Akron, and Canton Ohio areas. The advertisements will be through local nursing schools, professional networking organizations, and LinkedIn. All participants will either be a Nurse residents or have been practicing for a minimum of two years. Participants may have previously worked at other magnet status hospitals. Those who have worked at non-magnet status hospitals will only discuss their experience at the magnet status hospital.
Study Population and Data Collection
The population for this study will be comprised of Millennial Nurse Residents and experienced practicing Millennial Nurses. The Nurses will have between 0-12 years of nursing experience. They will have completed or currently be completing a residency. Ideally, half of the study population will be Nurse Residents and the other half experience, nurses. The population size will be at least twenty Millennial nurses, and no more than thirty.
Defining the population based on age, the length of practice, and whether or not they currently were, a nurse a magnet status hospital was done so purposefully to ensure the ability of participants to provide meaningful insight into Millennial Nurse’s education, values, and retention trends in a Magnet Status teaching hospital. This population allows for a correlation to be conclusive of the relationship between education, leadership, morale, and retention. Education, leadership, and morals together impact the retention of Millennial Nurses will create a certain understanding and assist Magnet status hospitals in identifying successful teaching methodologies preferred by Millennial nurses.
Nurses that are interviewed will have completed a nursing orientation training of at least ten weeks and have completed a minimum of three development or continuing education classes. Millennial nurses learn and retain information differently. Their values are different than other generational cohorts, requiring specific teaching methodologies, leadership techniques, and morals to be high to keep Millennial nurses. We can infer moral is tied to education and development, as well as leadership. The participants will complete semi-structured interviews. The phenomenological interview is a means of exploring and gathering material (van Manen, 2016). Commonly this is achieved by a series of meetings. The aim of the series of interviews is for pre-reflective experiential accounts (van Manen, 2016). The interviews serve the purpose to gather information regarding the perception of the effectiveness of the orientation, the total number of participants that completed it, and if they believe the teaching methodologies impacted resident retention. Perception will also be discussed in the training, development, and retention of practicing Millennial nurses.
Phenomenological analysis strives to develop an understanding of the experiences or phenomena of Millennial Nurses. Specifically, the analysis will reveal any patterns or phenomenon as it relates to Millennial Nurse Retention and the relationship teaching methodologies and leadership have on retention at Magnet status hospitals. The study seeks to understand the underlying contributors to Millennial nurse retention and the impact teaching methods, development, morals, and leadership have. This study will be completed through multiple interviews, requiring a combination of analytical approaches to identify any patterns or changes in the perception of the participants. A multiple interview approach was used to gather insight and develop relationality.
Coding will be used to analyze the data. First and second coding will be utilized. The first cycle of coding is the process that occurs during the initial coding. The second cycle of coding is classifying and prioritizing identified concepts or patterns. This is used to build a theory based on the results of the interviews. A code frequency report or basic coding can determine the rate of themes depending on the number of times different participants mention a particular word, feeling, or idea (Saldana, 2016). Reviewing recorded interviews will allow patterns to be identified. Categorizing patterns for interpretation, and referring to coding will lend to credible analysis. After the initial examination, it will be critical to reevaluate the data. The intended goal is to discover themes of the reflective experiences as they are being lived. Phenomenology is a method of questioning, not answering (van Manen, 2016). This will require repetition.
Each phase of interviewing will reveal perceptions critical to understanding Millennial nurse retention patterns, contributing factors, and the impact teaching methodologies have. The initial interview will establish the participant met the predetermined criteria and reveal the initial attitudes and perspectives of the Millennial Nurse residents and practicing nurses. The series of interviews shows changes in residency cohort sizes, retention factors, the perception of teaching methodologies, and development. The interviews will further identify the relationship linking teaching methods, morals, and leadership to Millennial nurse retention. The interviews will provide the individual perception of what has caused Millennial nurses to stay at their hospital or leave.
The fourth chapter will discuss existing perceptions and retention theories surrounding Millennial nurse retention. The focus will be on the contributing factor of how Millennial nurses are taught and retain the information being taught. Millennial values, moral, and the impact leadership have will also be discussed. Discussion of the post-interview follow-up will reveal changes in perception or retention over the specified period. The study will report on patterns of Millennial values as they relate to retention, and discuss in detail teaching methodologies used versus what is preferred by Millennial nurses. When considering experienced Millennial nurses, the paper will discuss the impact teaching and development had on their longevity at the magnet status hospital, or the impact it had on them changing jobs multiple times.
Limitations of the Research Design
The study was developed with a desire to understand the experiences and perceptions of Millennial Nurses and how they are taught or learn, and the impact this has on retention. The desire to learn more stemmed from being a Nurse Recruiter and analyzing retention data specific to one Healthcare Institute. The procedures were based on existing research and did not definitively answer a question but proved to be exploratory. The research technique relied on interviews, therefore providing credibility through firsthand accounts.
The data collected is narrow in scope due to sample size and is limited by the questions used for inquiry. The interviews will be conducted in confidence and participants will be assured of confidentiality. The data from the interviews will be compiled and coded for patterns. Emotion coding will be used throughout the data analysis process and documented throughout the interviews. Emotion coding was selected because emotions are universal to human experience. The researcher, in this case, myself will have the opportunity read non-verbal cues and infer understanding from the participants (Saldana, 2016).
Addressing retention issues that directly relate to teaching methodologies, morals, and leadership with nursing education and hospital leadership is an anticipated outcome. Hospital administration, nursing leadership, and nursing education supported my interest in the topic and provided some general guidelines for offsite research. The study population will be small. Consistent communication will increase the study’s credibility.
The expected number of participants will be small. An estimated twenty no more than thirty Millennial Nurse residents and practicing nurses will be interviewed. The characteristics of the participants will be vetted through a preliminary interview to ensure they meet the necessary criterion. The interviews will provide highly detailed insight into the understanding of attitudes and perceptions to aid in drawing meaning and understanding the needs and values of Millennial Nurses, including how they learn. The intent is to understand the effectiveness or shortfall of the residency and development is provided. This is intended to increase retention at Magnet hospitals with adequate training and development. The study is limited in transferability and could be impacted by other variables such as demographics or geographic location.
Ethical Issues: Conflict of interest assessment.
There are no conflicts of interest in this study. Recent residency and engagement surveys indicate that teaching methodologies are an active contributor to whether a nurse is engaged and retained. According to Montenery (2013), this is consistent with the Millennial nursing students, a survey of 57 nursing students revealed instructors needed to utilize new teaching technologies for Millennial nursing to student learning, and retain information. The investigation seeks to understand the impact of teaching methodologies, morals, leadership, and Millennial nurse retention. The intention is to develop best practices that have the potential to become part of the changes instituted by Nursing education at a Magnet status teaching hospital.
Millennial Nurse Retention is impacted by several factors. According to Case et al. (2004), the quality of the clinical orientation, residency, nursing leadership, professional development, and transition influence the nurse’s experience, therefore impacting the hospital’s likelihood of retaining them. As a nurse recruiter and change management professional working directly with nursing education, I have identified retention trends at Magnet status teaching hospitals. The majority of research indicates that nursing students or graduate nurses, in this case, prefer flipped classrooms and interactive teaching and learning, but this is not a common practice in nursing education (Towle and Breda, 2014). Additional teaching methodologies are recommended to impact learning outcomes and retention. Hospital leadership and nursing education will be informed of the importance of utilizing teaching methods preferred by Millennial nurses as a retention strategy.
Ethical Issues for the proposed study.
The study lacks identified ethical issues. As the researcher, there is no risk of known penalties to myself or the participants. Participants may hesitate to participate out of concern of ramifications if the information is shared with their employer. Ensuring that members know this information is confidential will be necessary to limit hesitation. As a means of providing comfort for the participants, the interviews will be conducted at a location identified by the participant and only recorded with their written consent.
The methods chapter details the procedures I will use to study Millennial Nurse retention 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. I will gather data through multiple interviews. I will learn and analyze motivating factors. Retention statistics if available will be reviewed. As an example, if a participant is part of a residency cohort I will seek to gather data indicating the number of nurse residents that started, still in the residency, and if a practicing nurse I will attempt to pick how many nurse residents they completed their residency with and how many they started with. The study population will be small, requiring regular communication. The methods used will be to complement existing research and were determined to be appropriate. In the next chapter, I will discuss the data collected and the analysis conducted.
Adkins, A. (2016). Millennials: The Job-Hopping Generation. Business Journal.
Anderson, G., Hair, C., & Todero, C. (2012). Nurse Residency Programs: An Evidence-Based Review of Theory, Process, and Outcomes. The Professional Journal of Nursing,28(4),203-2012.
Anderson, T., Linden, L., Allen, M., Gibbs, E. New graduate RN work satisfaction after completing an interactive nurse residency. JONA. 2009;39:165–169.
Casey, K., Fink, R., Kurgan, M., & Props, J. (2004, June 4). The Graduate Nurse Experience. JONA, 34(6), 303-311. Retrieved November 25, 2016, from https://www.researchgate.net/profile/Regina_Fink2/publication/8517544_The_graduate_ nurse_experience/links/00b4952e3cc246c730000000.pdf.
Dannar, P. R. (2013). Millennials: What They Offer Our Organizations and How Leaders Can Make Sure They Deliver. The Journal of Values-Based Leadership,6(1), 1-13. Retrieved January 11, 2017, from http://scholar.valpo.edu/cgi/viewcontent.cgi?article=1073&context=jvbl
Gilbert, J. (2011). The Millennials: A new generation of employees, a new set of engagement policies. Ivey Business Journal, (September/October).
Hall, M., Sheakley, M., Callender, D., Pederson, D., Gilbert, G. E., & Leighton, K. (2016). Enhancing Knowledge Retention of Cardiovascular Physiology Using Simulation. Medical Science Educator,26(1).
Hancharik, S. D (2008). Effects of instructional technology integration strategies in orientation programs on nurse retention in magnet and non-magnet hospitalsAvailable from ERIC. (964192708; ED527365). Retrieved from http://cupdx.idm.oclc.org/login?url=http://search.proquest.com.cupdx.idm.oclc.org/docvi ew/964192708?accountid=10248
Lott, T. F. (2006). Moving forward: Creating a new nursing services orientation program. Journal for Nurses in Staff Development, 22(5), 214-221.
McLeod, S. (2008). Educational technology leadership. Technology & Learning,28(11), 4. Retreived rom http://search.proquest.com.cupdx.idm.oclc.org/docview/61957650?accountid=1024 8
Montenery, S. M., Walker, M., Sorensen, E., Thompson, R., Kirklin, D., White, R., & Ross, C. (2013). Millennial generation student nurses’ perceptions of the impact of multiple technologies on learning. Nursing Education Perspectives, 34(6), 405-9. Retrieved from http://search.proquest.com.cupdx.idm.oclc.org/education/docview/1465297229/fulltextP DF/100B0320DFFE44AFPQ/1?accountid=10248
Towle, A., & Breda, K. (2014). Teaching the Millennial Nursing Student: Using a “Flipping the Classroom” Model. Nursing and Health, 107-114. Retrieved November 25, 2016, from http://www.hrpub.org/download/20150101/NH1-16802961.pdf
Van Manen, M. (2016). Phenomenology of Practice: Meaning-Giving Methods in Phenomenological Research and Writing. London: Routledge.