EDITOR'S NOTE: Carole Jakucs, MSN, RN, PHN, is a freelance writer.
With nurses from five different generations currently working — the Silent Generation (aka Traditionalists), Generation X, millennials and now Generation Z, how do we achieve maximum collaboration so nurses function as well-oiled, cohesive teams?
We’ve known for more than 20 years the importance of having nurses from different generations work well together, regardless of their generational and individual differences, for the good of the team and for optimum patient outcomes.
Collaboration between leadership and staff is key
Recognize triumphs and use talents
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Recognizing differences can change the trajectory of a relationship from one fraught with frustrating differences to one of valuing each other’s strengths, Bosworth said.
“Several years ago, when I was a new nurse, I precepted a nurse on her third career who was 30 years older than me and very smart,” she said. “I wondered, ‘What can I teach this person?’ At some point early on she said to me, you have so much to teach me and I have so much to learn. Right then we both realized there was a lot to learn from each other — our relationship became symbiotic.”
Switching from a judgmental attitude about differences to an appreciative attitude of someone else’s perspective can be helpful, Bosworth said.

“Recognizing the diversity another person’s experience brings to the table, not only due to their generation but also as a result of their gender, ethnicity, background and who they are as an individual, can go a long way to build good relationships," he said.
Susan Bosworth, RN-BC
Kathy Mertens, RN
Keller, who oversees nurse managers at NYU, said one motivator valued and brought to light by millennials is the concept of recognition.

“Over time there has been a cross-pollination of values,” he said. “We’re now seeing that the recognition typically provided once every year during annual reviews is not enough. The influence of millennials has fanned out, the result of which is entire teams now want to be recognized and receive regular feedback. They don’t want to wait for one year to get it.”
Using each nurses’ talents also is a big deal for nurses. According to the literature, some individuals of each generation may have specific traits and interests.

Identifying the talents and aptitudes of nurses, and using them to improve patient care and create a better work environment, can help keep staff engaged and encourage loyalty, Sharifi said.
“You need to create an atmosphere with opportunities for people to grow in the profession and make them feel they are part of the team,” she said. “Providing nurses with a chance to work on a challenging project that interests them can help keep the job fresh and promote a sense of belonging. One example is a nurse who loves neurosurgery cases can work to develop a new policy or process based on new evidence and present his or her idea to leadership and staff.”
Value others’ strengths
One way to bring about collaboration between the generations involves skilled nursing leadership. Good managers play a large part in creating strategies and knowing when to shift them when the conditions demand, to help the generations come together and develop a better work environment, said Ronald Keller, PhD, MPA, RN, senior director of nursing at NYU Langone Health in New York.
“As a leader, when you have a diverse group of staff in front of you, your role is to adapt to them, and change your approach and practice as needed, recognizing folks will think and respond differently to various situations,” Keller said. “Further, each generational group has key motivational factors that may differ from other generations according to the literature.”
Another healthcare organization that enjoys a diverse staff is Good Samaritan Hospital in Los Angeles.

Nurses from three generations work in the operating rooms at Good Samaritan, said Yasmine Sharifi, MSN, RN, CNOR, director of perioperative services at the Frank R. Seaver Ambulatory Surgery Center at Good Samaritan Hospital.
“A majority of our nurses are millennials and Generation Xers — we have some baby boomers too,” said Sharifi. “In the past, nurses could only work in the OR after having at least two years of floor experience. Now with perioperative programs available for new grads, we’re seeing more seasoned, experienced nurses working alongside newer, less experienced nurses, whom we’ll pair up during training.”
When differences of opinion exist, it’s important that nurses listen to each other to bring the two sides together, said Sharifi.

“It’s essential that older nurses listen to younger ones and younger nurses listen to older ones," she said. "Everyone has a voice. Encouraging communication between the generations can increase staff’s ownership of a new practice or procedure — and the whole process of implementation works better.”
As a nurse leader, Sharifi said her goal is to bring everyone together as a group.

“I encourage team work and value getting buy-in from my staff, rather than giving a one-sided perspective, especially when implementing any change to processes or practice," she said. "I want everyone’s viewpoint — and I listen to what they say."
In addition to healthcare organizations creating a culture in which managers provide regular feedback, recognition and professional opportunities to their nurses, another important aspect of encouraging collaboration between different generations is for managers to adapt their communication styles to the needs of each staff member, Keller said.
“I try to impart to my nurse leaders that a cookie-cutter style of communication is not what we’re about,” he said. “One style of communicating with one individual may not work for another. I, too, alter my style as needed. I will speak differently with a nurse who has 30 years of experience, than I would to a nurse who has been in the role for only two years. It’s my job to adapt to them. I encourage my direct reports to do the same with their staff."
Ronald Keller, RN
As a leader, when you have a diverse group of staff in front of you, your role is to adapt to them, and change your approach and practice as needed, recognizing folks will think and respond differently to various situations.”
— Ronald Keller, RN
It starts with effective leadership
Teamwork is critical in healthcare, said Kathy Mertens, DNP, MPH, RN, associate chief nurse and assistant administrator at Harborview Medical Center in Seattle and president of the American Academy of Ambulatory Care Nursing.

“In addition to generational differences due to birth year, other factors can contribute to differing views on a team, such as life events, family background, ethnicity, race and gender," she said. "Despite our differences, at the heart of achieving cohesive, efficient teams is having effective communications between staff, between staff and patients, and good technology to support the work."
Creating consistent communication tools that are reliable works across the generations, said Kathleen Martinez, MSN, RN, CPN, clinical policy oversight manager at Children’s Hospital in Aurora, Colo., and a director on the AAACN board of directors.

“We have found there is better uptake of information by staff when information is developed centrally, then disseminated at the local or unit level," said Martinez, who manages more than 1,000 policies in her role at the medical system. "This provides the nurse manager and educators working with each unit to tailor the delivery for their staff."
Differences don't have to divide
Another idea is to identify tech-savvy staff to help train others. Last year at Vanderbilt University Medical Center in Nashville, Tenn., a new electronic medical record system was implemented, which created some challenges but also opportunities, said Susan Bosworth, MSN, RN-BC, FNP, nursing education specialist in the department of Nursing Education and Professional Development at Vanderbilt Medical Center.

“For some in the younger generations, transitioning to the new system was a bit easier,” she said. “For some of the older, more seasoned staff members, it was a bit more difficult. However, it created an opportunity for us to provide different options for training to target the various ways that individuals learn — traditional classroom as well as peer-to-peer, hands-on training on the units.”
Kathleen Martinez, RN

A multigenerational workforce can be unified by leadership

Age doesn’t have to interfere with nursing collaboration
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By Carole Jakucs, MSN, RN, PHN
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