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Intergenerational Workplace of Nursing CE Course

1.5 ANCC Contact Hours

About this course:

This module explores the current culture within the various generations in nursing. It also aims to develop an understanding of the unique challenges inherent in an intergenerational group's collective functioning, communication, and teamwork.

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Intergenerational Nursing

Disclosure Statement

This module explores the current culture within the various generations in nursing. It also aims to develop an understanding of the unique challenges inherent in an intergenerational group's collective functioning, communication, and teamwork.

Upon completion of this module, learners should be able to:

  • discuss the key differences in the five current generations of nursing
  • explore the motivators for each generation in nursing
  • describe strategies to manage the different generations in the workplace effectively


Disclaimer: This module's purpose is to explore ways to decrease generational gaps in the workplace. Descriptions of the five generations within this activity may appear stereotypical; these generalizations are not intended to classify individuals but rather to capture how various generational groups may view each other and how this may lead to conflict. These observations are not intended to be derogatory or judgmental and do not apply to all members of the generations discussed.

Healthcare organizations employ a very diverse group of workers. There is diversity among educational preparation, culture, race, language, and experiences, as well as among generational groups. There are up to five generations actively employed within the current healthcare setting. Intergenerational diversity can create challenges for healthcare executives, managers, educators, and individual nurses across various healthcare settings. Differences in life experiences, work ethic, values, or culture can lead to conflict between coworkers. Therefore, healthcare leaders need to understand the various generational differences, including the key motivators in each generation, and strategies to effectively manage the conflicts while promoting a positive and collaborative work environment (Graystone, 2019; Moore et al., 2016).

Generations in Today's Workplace

According to the American Nurses Association (ANA), there are currently 4.3 million registered nurses (RN) working in the US across various healthcare settings. In the last decade, the nursing workforce has faced significant challenges, including the increasing complexity of care and staffing shortages. Even before the Covid-19 pandemic, nursing shortages were prevalent due to nurses retiring and the increased demand for healthcare. With the aging nurse workforce, 17% of nurses globally are expected to retire by 2030, with additional nurses choosing to leave the profession for other reasons. Although nursing turnover is a complex phenomenon, generational differences are one factor contributing to the current nursing workforce challenges. With varying perceptions of employer loyalty, motivating factors, and job satisfaction, healthcare organizations must find solutions that address the needs of nurses across various generations (ANA, n.d.-b; International Council of Nurses, 2020).

The US Bureau of Labor Statistics projects that between 2020 and 2030, there will be approximately 203,200 yearly openings for RNs. They also project that RN employment will rise by 6% during this period, making it one of the top occupations in job growth. Every 2 years, The National Council of State Boards of Nursing (NCSBN) and The National Forum of State Nursing Workforce Centers conduct the only national-level survey focused on the US nursing workforce. In their most recent survey (2020), the median age of RNs was 52, and the average age of licensed practical nurses (LPNs) was 51. Nurses over 65 account for 19% of the RN workforce and 18.2% of the LPN workforce (Smiley et al., 2021). See Table 1 for the full breakdown of the RN and LPN workforce by age.

Table 1

Registered Nurse and Licensed Practical Nurse Workforce by Age

Age Range



18 to 29



30 to 34



35 to 39



40 to 44



45 to 49



50 to 54



55 to 59



60 to 64



(Smiley et al., 2021)


The five generations currently employed in healthcare are the Veterans, Baby Boomers, Generation X, Millennials, and Generation Z (Moore et al., 2016). See Table 2 for the generally accepted birth years associated with each generation.


Table 2

Generations Currently in the Workplace

Generation Name

Birth years


Born between 1922 and 1946

Baby Boomers

Born between 1946 and 1964

Generation X

Born between 1964 and 1980


Born between 1980 and 2000

Generation Z

Born between 2000 and 2012

(Graystone, 2019; Moore et al., 2016)

Each of the five groups had very different experiences as they grew up, and those experiences impacted their values and perceptions of work. Members of each generation generally experience the same cultural events, hear the same type of music, and experience the same national figures, catastrophes, and social and cultural achievements or failures. All these experiences contribute to the development of similar attitudes based on the norms of that time. For those rare remaining nurses who grew up in the Veterans group, World War II and a very strict upbringing with military values generally shaped their work ethic. These individuals have strong beliefs about respecting others and authority. The quality of their work is a deeply held value. Baby Boomers, the largest population of employees currently saturating the workplace, embrace the value of sacrifice to succeed and are bound by loyalty and respect for authority. Members of Generation X grew up in a time shaped by evolving technology and typically represent a shift in focus from the number of hours worked to productivity. This group is very outcomes-focused and more concerned with getting the job done rather than clocking in and out to determine their dedication to work. Millennials and Generation Z have been

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immersed in technology since birth and are often viewed as deft multi-taskers who are easily bored. They understand how to utilize technology to their advantage to do their jobs efficiently. Millennials value a balanced work/life schedule and equality in the workplace. Generation Z is the most highly educated generation in history (Graystone, 2019; Moore et al., 2016; Stevanin et al., 2018).

Differences in communication between individuals that may be as many as 70 years apart in age are notably recognized. Veterans tend to respond optimally to managers that respect their experience and knowledge and offer frequent feedback to confirm their abilities. They like to know their place within the organization's hierarchy and value their standing. Baby Boomers are often motivated by opportunities to learn new skills that increase their standing in the organization. Individuals in Generation X tend to prefer to work independently with little oversight and place a high value on their personal life and leisure activities. This generation often follows the motto of working to live, not living to work. Millennials and Generation Z share many values with Generation X, such as working to live; however, unlike the Generation X group, Millennials like to work in teams, receive frequent feedback, and work with the most updated technology. Generation Z does not find change intimidating and appears nimble and flexible (Graystone, 2019; Moore et al., 2016; Nwosu et al., 2016).


Differing views by the various generational groups also include perspectives on education, work, and relationships. Most Veteran group members did not have the opportunity to attend post-secondary school and likely began working immediately after high school or entered military service. Their goal with employment or military service is to support their families. The Veteran group grew up during the Great Depression and understands hard economic times; they want to provide their family with more than they had growing up. Most Veterans entered the workforce at a time when an individual would be hired by an organization and stay there until retirement, perhaps moving through positional advancement along the way. This group is loyal to their employer and highly respects the chain of command. Furthermore, they believe something should not be fixed if it is not broken. They value hard work and dedication, are team players, and obtain satisfaction from doing their work well (ANA, n.d.-a; Hisel, 2020; Nwosu et al., 2016).

Baby Boomers

Baby Boomers currently make up a significant portion of the population, with an additional 17,000,000 babies born during this period compared to previous generations. They grew up during a more prosperous time than their parents and grandparents. Their lives were influenced by the civil rights movement, the women's rights movement, the cold war with Russia, the Vietnam War, and even the NASA space program. Due to prosperity, this group has optimism and believes their generation changed the world. Like Veterans, other generations may consider Baby Boomers workaholics that tend to be rigid or inflexible. Both groups have strong work ethics characterized by dedication and loyalty. They do not mind working long hours and expect respect. Many Baby Boomers built outstanding careers from the ground up and devoted large parts of themselves to their jobs. This generation lives to work and finds great pride and intrinsic motivation from their work. They are highly competitive, and due to their large numbers, they often must compete with peers for promotions and career advancement opportunities. This was the first generation in which both parents commonly worked outside the home, creating a generation of children who went home to an empty house (latch-key kids). Baby Boomers are still loyal to their employers but are more loyal to their careers and are not opposed to changing jobs for higher salaries or better opportunities; however, they do not change jobs easily. They seek status and feel that success is important, so a change in job title may be the impetus for a job change. Many in this generation have already achieved many of their career goals yet still appreciate opportunities for career advancement linked to salary increases (ANA, n.d.-a; Davis, 2017; Nwosu et al., 2016).

Generation X

Generation X is often considered a misunderstood group. This was the first generation with access to the internet and personal computers as children or young adults. They welcome diversity and change and value their free time and having fun. Generation Xers were raised by Baby Boomer parents focused on getting ahead and working hard. Thus, many Generation X individuals were latch-key kids who were at home alone until their parents could leave the workplace. They had increased access to technology, and television or video games were often referred to as their "babysitters." Since Baby Boomers raised them, they have a very different view of work-centric parents and tend to be very independent and self-reliant. Generation Xers are often entrepreneurs and embrace change in the workplace. They like a flexible workplace and may choose to work from home 2 or 3 days per week versus going into the office daily in their eternal quest for balance. They value constructive feedback that aids in their growth and development. Most Generation Xers are highly educated and in line for advancement when Baby Boomers in leadership roles retire. In contrast to Baby Boomers, this group thrives on diversity, challenges, honesty, and creativity (ANA, n.d.-a; Nwosu et al., 2016; Stevanin et al., 2018).


Millennials have many labels, including Generation Y, Nexters, Generation www, and the Digital generation. The group was practically born with digital phones in their hands, and technology is as much a part of their lives as food and water. Many have grown up in a multi-tasking environment with school, dance, sports, and other extracurricular activities. They thrive off instant gratification and instant feedback for their performance. They are high-achieving, confident, and team-oriented but may also be considered high-maintenance and high-risk. This group has been shaped by parental spoiling and excesses, computers and the latest technology, and social media over the last 15 years. They seek flexibility and want a balanced life with clear goals. They are adaptable to constant change and have no desire to stay in the same job for extended periods. Millennials value diversity and training and want to be challenged. They expect to be paid for what they do, not how many hours they spend doing it. They strive to be at the top of the organizational hierarchy quickly, crave frequent feedback from their supervisor, and are very optimistic and confident in their abilities. Like Generation Xers, older coworkers may categorize Millennials as entitled, lazy, and disrespectful of authority (ANA, n.d.-a; Keith et al., 2021; Nwosu et al., 2016; Veesart, 2018).

Generation Z

While Millennials were immersed in technology early in their lives, Generation Z could be said to have a smartphone as their right hand. This group coined the phrase "influencer" and are strong multi-taskers. Merriam-Webster (n.d.) defines an influencer as "a person who inspires or guides the actions of others." This group uses YouTube, Instagram, or other social media platforms to share the latest technology, clothing, styles, or trends and influence the actions of others, including purchases, travel, or behaviors. The average attention span of a member of Generation Z is less than 8 seconds due to immediate answers through the internet, infinite choices, and multiple screens. This group understands how technology has transformed the workplace, and they aspire to work with organizations that value cutting-edge technology and allow them to influence how others work. Generation Z believes that many current jobs will not exist in the next 2 decades, and they understand that change is inevitable. They use their smartphones 5 or more hours per day, some over 10 hours per day, and have a different view of the work environment than previous generations. Generation Z is the most highly educated, as college enrollment and completion are higher than any prior generation across all diversity subgroups. Most Generation Zers place low value on company loyalty and move between jobs easily (ANA, n.d.-a; Chicca & Shellenbarger, 2019; Hampton & Welsh, 2019).


In many workplaces, it is noted that a third "ism" is present, in addition to racism and sexism, known as ageism. Ageism is not only focused on those growing older but rather a "prejudice or discrimination against or in favor of an age group" (Palmore, 1999, p. 4). Research has shown that ageism negatively affects the workplace, adding to intergenerational conflicts. This may include the tendency for older adults to be ignored for hire or promotion in favor of younger, equally or less-qualified candidates. King and Bryant (2017) introduced the Workplace Intergenerational Climate Scale (WICS) as a measuring tool for employee attitudes and perceptions about coworkers of various ages. This tool contains 18 items reflecting five subscales: intergenerational contact, intergenerational retention, positive intergenerational affect, generational inclusiveness, and lack of generational stereotypes. The scores on the subscales are linked to workplace mentoring, opinions about older workers, and overall job satisfaction. By using the WICS tool, an organization can help define its culture and make changes related to intergenerational challenges (King & Bryant, 2017). See Table 3 for WICS Items.


Table 3

Workplace Intergenerational Climate Scale 18-Item Tool

  • LGS1: Coworkers outside my generation are not interested in making friends outside their generation.
  • LGS3: Coworkers outside my generation complain more than coworkers my age.
  • PIA1: I feel comfortable when coworkers outside my generation try to make conversation with me.
  • PIA2: I enjoy interacting with coworkers of different generations.
  • PIA3: My coworkers outside my generation are interesting and unique individuals.
  • IC1: How often do you have conversations with coworkers outside your generation?
  • IC2: How often do you have conversations with coworkers outside your generation relating to things other than work?
  • IC3: How often do you talk with your coworkers outside your generation about your personal lives?
  • IC4: How often do you interact with your coworkers outside your generation at company-sponsored events?
  • IC5: How often do you eat meals with coworkers outside your generation during the workday?
  • WGI1: I believe that my work environment is a healthy one for people of all ages.
  • WGI2: Workers of all ages are respected in my workplace.
  • WGI4: I am able to communicate effectively with workers of different generations.
  • WGI5: Working with coworkers of different ages enhances the quality of my work life.
  • WGI6: My coworkers make older workers feel that they should retire.
  • WGI7: I feel pressure from younger workers to step down.
  • WGI8: I feel pressure from older workers to step down.
  • GARF1: People work best when they work with others their same age.

(King & Bryant, 2017)

The researcher's application of the WICS tool to a healthcare organization providing care to seniors was significant. The employee sample median age was 43 years; 24% of respondents were younger than 30 years of age, 40% were 31 to 49 years of age, and 36% were 50 years of age or older. Of those surveyed, 75% identified as White, 16% identified as Black, 3% identified as Asian, and 3% identified as Hispanic. Ageism and bias toward older workers were noted in this study. While this tool does not define an organization, it can give an overall picture of its intergenerational climate and employee perceptions. Further, recognizing bias, opportunities, or successes concerning intergenerational challenges can be positive for workers of all age groups (King & Bryant, 2017).

Motivators for Each Generation

Individuals have intrinsic (internal) and extrinsic (external) motivators to go to work. While everyone desires to have their basic needs met, such as shelter, food, and clothing, other motivators cause individuals to seek certain career choices or develop certain habits and norms in the workplace. Veterans report motivation through financial compensation yet desire respect. They tend to prefer milestone recognition in the workplace and are proud of that "5-year, 10-year, and 20-year pin" to recognize their loyalty to an organization. This group values promotions, personal recognition, and feedback from their managers. Benefits that often motivate their workplace choice include long-term care insurance and catch-up retirement funding (ANA, n.d.-a; Davis, 2017; Moore et al., 2016; Stevanin et al., 2018).

Baby Boomers tend to be similar to Veterans, but a striking difference is in recognition in the workplace. Baby Boomers prefer peer recognition over supervisor recognition and appreciate non-monetary benefits such as flexible retirement planning. They like prestigious job titles, personal parking places, and large offices. While they appreciate features such as 401K matching, sabbaticals, and catch-up retirement, these may not be the driving forces to choose a workplace. Baby Boomers like to be in positions of power, and job titles are significant. They also appreciate high-quality health, long-term care, and disability insurance (ANA, n.d.-a; Davis, 2017; Moore et al., 2016; Stevanin et al., 2018).

Motivators for Generation X include bonuses, such as stock or monetary rewards for a job well done, or flexibility as a non-monetary reward. They like informal, rapid, and publicly announced positive feedback. Preferred extrinsic motivators include telecommuting and tuition reimbursement. This group appreciates recognition from their boss, gift cards, experiential rewards such as conference attendance, and schedules with flexibility. They value benefits like health insurance and even disability insurance but do not report a great desire for long-term care insurance. They believe that advancement in a company should not be based on the years served but rather on performance and competence in the role (ANA, n.d.-a; Davis, 2017; Moore et al., 2016; Stevanin et al., 2018).

Millennials are typically motivated by skills training, workplace culture, and flexible schedules. Their preferred recognition style is regular, ongoing, and informal feedback from peers and managers. They appreciate recognition through company newsletters or social networks. Welcomed benefits for this group are flexible schedules and continuing education. They prefer stock options as their monetary reward over raises or bonuses. They have less appreciation for benefits like long-term care or disability insurance; however, they appreciate substantial health insurance (ANA, n.d.-a; Davis, 2017; Moore et al., 2016; Stevanin et al., 2018).

Generation Z appreciates constant feedback from peers and managers; they often prefer social rewards over money. These individuals need to know that their work impacts the entire organization and where they fit in the "big picture" of the company. They challenge leaders to think differently and consider changing their operational model. They question paradigms and why things are done the way they are. They thrive on experiential awards like badges won in video games. They demand and expect workplace flexibility and diversity. Generation Z thrives off regular, in-person, and public praise from managers and peers. They welcome benefits such as online training and certification programs. They do not value benefits like health insurance, long-term care insurance, or disability insurance as much as their predecessors do (ANA, n.d.-a; Davis, 2017; Moore et al., 2016; Stevanin et al., 2018).

Strategies to Effectively Manage the Intergenerational Workplace 

Diversity in the healthcare workplace is a vital asset as nurses serve a diverse population. Nursing has long sought diversity among its ranks, and the intergenerational workplace is an opportunity for diversity that can best serve our patient population across the lifespan. However, McNally (2017) states that "a one-size-fits-all approach to leading in the midst of great generational diversity does not work" (para. 2). Generational conflict can result from misunderstandings, assumptions, or stereotyping. The younger group may become frustrated as Veterans and Baby Boomers struggle to master new technology, and the older group may view Millennials, Generation X, and Generation Z as lazy and obsessed with technology. Another stereotype is seeing the older worker as just waiting out their time for retirement. In reality, older workers sincerely want to contribute and be recognized for their value in the workplace. Mutual respect is the foundation of a workplace free of generational conflict. Mutual respect can be built through facilitated conversations focusing on team members' strengths. These conversations can increase awareness and introspection related to bias while simultaneously developing an appreciation and creating new ways of working together. The positive features of each generational group should be highlighted rather than discussing the negatives (Graystone, 2019; McNally, 2017; Moore et al., 2016). As leaders consider the culture of their organization and how to address intergenerational conflict, cross-generational leaders should be recruited to discuss the following questions (McNally, 2017):

  • What challenges are you finding as you work with multiple generations? What specific examples can you share?
  • What are leadership challenges occurring through managing the various generations?
  • Does our leadership team reflect generational diversity? Are there opportunities to do better?
  • What are the pitfalls of intergenerational communications, and how can they be improved?
  • What new approaches could be implemented to serve all the generations best?

Leaders must be flexible and strive to understand each generational group to meet the needs of their entire workforce while building teams that can work collaboratively. Consider how the generational groups that often have such great divides can come together and care for the patients served by all. To build bridges among the groups, consider the opportunities for each group to mentor or coach the others. Gratton and Scott (2016) noted that the younger generations could impart networking skills and reputation-building to the older generations, while the older generations can impart general life wisdom and financial knowledge. There is much more to consider across the generations. A Harvard study surveyed over 10,000 individuals and asked about work and life experiences. Some of the questions posed were (Gratton & Scott, 2016):

  • Are you actively building, maintaining, or depleting tangible assets such as financial savings?
  • Are you actively building, maintaining, or depleting intangible assets, including productivity (skills, supportive peers, good reputation); vitality (health, managing work/life stress, and relationships); and transformational capacity (self-knowledge and investment in extended networks of friends and colleagues)?

These questions inquire about aspects of life that are vital to creating a long and productive work life. Their findings indicate significant differences between generations. Across the generations, there is an opportunity for mentoring and coaching that could enhance each age group's professional skills. A specific area of opportunity for the younger generations to learn from the older generations was in control of their work stress. Insights from the older generations were developed over years of learning how to control their work life. Older generations were better skilled at delegating to others, pushing back to management when needed, and accepting demands when appropriate. Another opportunity for younger generations to learn from older generations is financial proficiency. In general, the young generations are less comfortable managing personal finances or financial literacy. Older generations can provide insight into their future, decrease future financial problems, and enhance their retirement ability (Gratton & Scott, 2016; Graystone, 2019; Moore et al., 2016).

The researchers also found opportunities for older generations to learn from younger generations, such as building crucial relationships and networks across the lifespan. New skills acquired through mentoring and coaching can transform the individual and their marketability in the workplace. Data shows that employees over 50 tend to maintain their current network and fail to expand or build new ones, particularly among younger workers in the workplace. This can lead to stagnation, with less challenge or development in workplace skills. In younger individuals starting their careers, networking skills, building diverse relationships, and finding coaches and mentors are second nature. Being resilient is vital to remain in the workplace, even when aging. Maintaining relationships between the older and younger generations can be a win-win for both groups. Building a professional reputation is another crucial aspect of career development that younger workers can often share with older workers. Social media platforms such as LinkedIn, a resume, curriculum vitae (CV), and professional references can cooperatively drive an individual's reputation (Gratton & Scott, 2016; Graystone, 2019; Moore et al., 2016).

Nurse managers can use their knowledge of the differences between generational groups to build a strong workforce that can serve patients better. Tips for motivating the different generations include (Graystone, 2019; Moore et al., 2016):

  • Promote collaboration and celebration through social media platforms that allow employees to celebrate and share their successes.
  • Understand and learn to appreciate the different work styles between the groups and offer flexible work options where possible.
  • Make the patient the primary priority and bring the groups together for the common good, regardless of their age, beliefs, or social norms.
  • Enable personal work/life balance and professional growth since all generations have a mutual appreciation for this aspect of work.
  • Develop mentoring programs that build on the strengths of individuals. Consider a reverse mentoring program where everyone is both a mentor and a mentee.
  • Push for workplace policies and hiring processes that carefully select managers that reflect/respect the diversity of their workforce based on knowledge, skills, and attitude.
  • Encourage wellness among all age groups

A study from Slovenia on the differences in generations did not refer to the variances as "intergenerational conflict" but rather "intergenerational cooperation (Čič & Žižek, 2017)." In the study, many of the same concerns and patterns exist as they do worldwide, yet they voice these as opportunities to develop cooperation among individuals. The intergenerational cooperation implementation is divided into two categories: a) describing the levels of generational differences and similarities that affect the organization, or b) describing the areas of generational differences and similarities closely related to human resources management. The first considers organizational culture, management style, and communication concerning the intergenerational perspective. The latter focuses on management activities that are aimed at the implementation of intergenerational cooperation (Čič & Žižek, 2017).

Management support is vital for successfully implementing intergenerational cooperation; the company's policies, strategic direction, and values shape workplace culture. The initial step in intergenerational cooperation is manager training that focuses on age diversity strategies, vision, and current culture of the organization and how their actions will shape an overall culture change. A manager is often the mediator between conflicts of various generations and should have the skills to be receptive and understand the differences and similarities between the individuals. Clear guidelines should be established through policies so everyone can recognize and understand the expectations and their role in the process. The intergenerational cooperation model further acts as a continuum where the generations' diversity is recognized, appreciated, and implemented across the employee's work-life period. For this continuum to occur, an atmosphere of cooperation between the different generations must exist (Čič & Žižek, 2017).

Employee recruitment is the second step in intergenerational cooperation. Hiring a diverse workforce and adapting to generational diversity within the performance management process lays a foundation of expectation. The third area is employee development. Coaching and mentoring, succession planning, talent management, and knowledge management are key activities that retain and maintain employees. The final area is more directed toward individual generations and has targeted activities for each age group, such as a suitable working environment. This may include job rotation, an extension of the job, work sharing, or flexibility of work hours, but it focuses on intergenerational teams that allow for the transfer of tacit knowledge and encourages creativity and innovation within the team (Čič & Žižek, 2017).

Čič and Žižek (2017) concluded that organizations must recognize the differences between generations and appreciate those differences. They recommend that all employees sign a code of intergenerational cooperation, facilitate succession planning, and participate in job rotation programs. Administrators must create intergenerational teams with intention and remove barriers to collaboration among the generations, such as age or years of service for role ascension. Finding ways to work together in harmony can be very difficult in any organization, and healthcare has unique issues related to workplace civility and cooperation. However, the positive aspects of intergenerational differences and cooperation can be greater than the negatives if we all come together (Čič & Žižek, 2017).


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