Embracing a Multigenerational Workforce: A School Nursing Perspective

An essential but often underestimated area of nursing is the phenomenon of a multigenerational nursing workforce. Nurses from distinct generations have varied experiences, work habits, attitudes, and beliefs toward care. A generational cohort includes people who share birth years, past experiences, and everyday occurrences (Hisel, 2020). While not perfect, generational profiles help us appreciate how a generation’s life experiences influence the consideration and passion of people at a foundational phase in their lives and eventually touch fundamental individual ideals. These attributes should be embraced to support a more vital labor force that builds on the unique characteristics of each cohort.

The current nursing workforce primarily includes those from four generations: the Baby Boomers (1946-1964), Generation X (1965 and 1980), Generation Y (1981-1996), and Generation Z (1997-2012) (Dimock, 2019). The potential wealth of information gained from these four generations working together is tremendous, and nursing leaders and critical stakeholders should embrace and analyze it.

Generational attributes affect several areas of the work environment: job satisfaction, for example, intent to leave and work engagement; occupational-related well-being, including stress, resilience, and engagement; and practice and leadership aspects, involving autonomy, relationships, patient outcomes, and work ethic (Sanner‐Stiehr et al., 2021; Stevanin et al., 2018). Intergenerational workplaces and work teams may have misunderstandings, conflicts, and tensions among employees (Lowe et al., 2020). Each generation has different perspectives, values, and expectations. Developing skills to consider generational dissimilarities through a tolerant lens will allow nursing leaders to expand their management style, improve excellence and output, lessen inconsistency, and boost all contributions in the work setting.

This article offers a perspective on embracing a multigenerational workforce utilizing school nursing as an exemplar. We include a brief historical perspective of school nursing practice, an overview of the generational cohorts, and present strategies for school nurses to build cohesive health teams. This article encourages nurses to review perceptions about generational differences and view distinctions as strengths. The information shared is intended to promote dialogue and thoughtful translation to other nursing specialties.

School Nursing

School nursing is a focused practice that aims to safeguard student health, support academic success, and facilitate optimal development (NASN, 2016). Like other nursing specialties, school nursing is steeped in ethics and evidence-based practice. School nurses are responsible for bridging education and health care, coordinating and advocating for quality student-centered care, and collaborating with key stakeholders to support students. The National Association of School Nurses (NASN) Framework for 21st Century School Nursing PracticeTM aims to guide school nurses to maintain student health and academic achievement by backing a safe and healthy school environment (NASN, 2016). NASN strongly believes that incorporating this framework supports the professional school nurse at every level of practice and responsibly serves the community.

Building a Nursing Specialty

School nursing began in New York City in 1902, led by Lina Rogers, a public health nurse. Rogers was a pioneer who demonstrated the importance of working with the city’s most recent and destitute immigrants (Bergren, 2017; Struthers, 1917). She developed school health protocols and policies for specific ailments, examined ill youngsters, and expanded her energies to deliver care at home and school. Rogers convinced other public health colleagues to accompany her by completing home visits to tackle the socioeconomic factors that extended school absenteeism and sickness (Bergren, 2017; Struthers, 1917). Her work was an early example of nurses working together to address social determinants of health utilizing a public health approach focusing on education, well-being, illness prevention, and tackling issues such as hunger and housing concerns.

School nurses today emphasize health maintenance and health promotion. They offer health education, including anticipatory guidance, screening, and surveillance for school staff, students, and families. They administer care for chronic conditions such as asthma, diabetes, epilepsy, mental health issues, and obesity, as well as treat acute illnesses. The involvement in school-aged children’s health requirements has increased substantially since the early 1900s. School nurses are as essential then as they are now and are well-positioned to play a pivotal role in promoting health equity and academic outcomes by removing learning barriers (Johnson, 2017). Additionally, they are part of a directive to advance the profession, including demonstrating the vital work that school nurses do and revealing the value of working in a multigenerational profession.

In the most recent school nursing workforce study, Willgerodt et al. (2018) report that over 75% of the current public health school nursing workforce is over 40. The generational cohorts from the most recent data available indicate that among U.S. school nurses, approximately 48% are Baby Boomers, 28% are Generation X, and 24% are Generation Y. Specifically, 5.4% report their age as less than 30, 18.7% are between the ages of 31-40, 27.9% are between the ages of 41-50, 34% between 51-60, and 14% over 60. Of concern is that only 5.4% report being less than 30. This small percentage captures Generation Z and worries many about developing a school nursing pipeline, including the value of professional mentoring and specialty-specific knowledge shared among generations.

Embracing a Multigenerational Work Environment

Although there is no fixed beginning or end to generational groups, they usually cover 15 to 20 years (Sherman, 2006) and have value in understanding what the individual groups bring to nursing practice. The Baby Boomers grew up in a post-war economy, valued their individualism, and expressed themselves creatively. They are notorious for their resilient work ethic and evaluation of others (Sherman, 2006). Generation X includes a generation that witnessed an increase in divorce rates, single-parent households, and, for many, both parents working outside the home. For Generation X, technology has become an essential part of their lives with the increased usage of computers. See Table 1 for representative characteristics of the four cohorts.

Table 1. Generational Cohort Classification and Characteristics

Note. Sources: ^aChristensen et al., 2018; ^bDimock, 2019; ^cWillgerodt et al., 2018; ^dSmiley et al., 2021

Generation X differed from the Baby Boomers regarding the nursing workforce as they were a smaller group and had difficulty attracting nurses to the profession. The Generation Z cohort is often called the first digital natives (Parker & Igielnik, 2020). They are tech-savvy and prefer to send a text or an email rather than in-person communication (Parker & Igielnik, 2020). This group requests more work-life balance, wants more freedom and career choice options, and is viewed as more independent and entrepreneurial than prior cohorts (Kane, 2019). Currently, Generation Z is not highly represented in school nursing as nursing graduates tend to begin their career in the hospital setting, but this is a group that is welcome into school health to share their knowledge, enthusiasm for the profession, and familiarity with more recent training in things such as electronic health records and health-systems infrastructure.

The authors do not view knowledge shared among generations as unidirectional. The value of learning among all four practicing generational cohorts needs an enhanced understanding of quantitative and qualitative work, and therefore, we encourage greater research in this area. Like other nursing specialties, appreciating the school nurse’s role is essential, as the position, practice, and staffing are often misinterpreted. In school health, this misinterpretation was evident during the early months of COVID-19. For example, it was not the case for all schools to have a full-time onsite school nurse, and during the initial months of the pandemic, this surprised many (Strauss, 2020). School nursing leaders shared that the American Academy of Pediatrics (AAP) advises a full-time nurse every day in all schools (AAP, 2016), and it is the position of NASN that a “registered, professional school nurse is present in every school all day, every day” (NASN, 2022, para. 1).

The need for civic support, with guidance from multigenerational nursing leaders and other key stakeholders, was highlighted during the pandemic, as was the drive for policy to develop community backing and subsidies for school health services. The value of building strong school-community partnerships, having school nurses implement and lead such alliances, and emphasizing their value to families, schools, and communities was evident (McCabe et al., 2020). Nursing leadership must continue to highlight and share with a broader audience experiences of professional capability with health emergencies such as H1N1 and COVID-19, familiarity working with data and electronic health records, and recognizing the value, importance, and attributes that different generations bring to the work setting.

Considerations for the School Nursing Workforce

Opportunities for Advancement
The age of the school nursing workforce trends older, as more than 48% of school nurses are over 50 (Willgerodt et al., 2018). From our collective experience, many nurses in this age group followed a similar professional path. Nurses transitioned from other areas of nursing to school nursing and reported limited opportunities for professional growth within their schools or school districts. One reason for this limited mobility is the lack of infrastructure within school nursing to provide a pathway for promotion. Many school nurses have decades of nursing experience and leadership skills, yet the educational system does not offer opportunities for advancement. A concern within nursing should be an acknowledgment that while the Baby Boomers may have tolerated this outcome, the younger generation will not.

The experience of having multiple generations in the workforce is not uncharted territory for nursing. Perceptions of generational differences may result in workplace conflict, but we advocate for comradery and growth within the nursing profession by learning from each other. Our experience reveals that growing a dedicated school nursing workforce that welcomes all generations must include opportunities for advancement within the profession. The lack of a clear pathway for advancement or recognition of school nurses as leaders in educational systems has been a long-standing barrier to growing the specialty practice. The generations after the Baby Boomers are demanding more flexibility, autonomy, and opportunities for career advancement. This vocalization of job demands is where school nursing faces its most significant barriers to meeting the needs of the newest generations and must be addressed. It may take a new legion of nurses with a fresh perspective to change the landscape where school nursing leadership opportunities are the expectation and not the exception.

Diversity, Education, and Inclusion
There has been a considerable shift in racial and cultural diversity globally. Generation X and Generation Z individuals may be the most diverse generational cohorts. In response to a more diverse workforce, we will need a greater focus on social skills such as emotional and cultural intelligence and competency. Individuals from these cohorts may have less well-developed social acumen in emotional and cultural intelligence as they grew up primarily using smartphones and the internet rather than fostering in-person communication skills. Nurse leaders must be mindful of generational exposures and develop collaborative teams amidst diverse ones. Professional development and training are important considerations, not just with Generation X and Generation Z but with all generational cohorts who will benefit. Regardless of the generational cohort, racial, or ethnic group, all individuals intrinsically desire respect and value, which should be modeled in the workplace.

Mentoring
Sharing knowledge, wisdom, experience, and direction with less experienced nurses can influence the mentor’s personal and professional growth. Suggestions for nurses new to school nursing include contacting experienced school nurses for mentorship opportunities. While this may have some challenges, the authors advise looking within the district and using state and professional organizations for mentorship opportunities (Blake & Trano, 2022). Another recommendation is to develop a program called Reverse Mentoring, a model credited to Jack Welch, former Chief Executive Officer of General Electric (Satterly et al., 2018). Reverse mentoring values and intentionally utilizes the specific expertise of younger professionals who act as a mentor to senior colleagues. For example, the novice school nurse may have more experience with technology (i.e., use of social networks, electronic health records, and computer skills) and can share those skills while benefiting from the clinical wisdom and skills of an experienced nurse. Research supports pairing novice employees with experienced colleagues to foster relationships (Brizena, 2018; Browne, 2021; Satterly et al., 2018). Findings demonstrated that the relationships developed are reciprocal and promote value beyond knowledge exchange.

ACORN Model
By utilizing an inter-generational model such as ACORN, nurse leaders can foster an environment that builds on the strengths of generational diversity, teamwork, and collaboration (Zemke et al., 1999). The ACORN model is an acronym for: Accommodate employee distinction; Create workplace options; Operate from a learned management style; Respect capability and creativity; and Nourish retention. Note, this is a model over 20 years old, suggesting that managing generational differences is more about the worker as an individual, not a stereotyped member of a generational cohort.

For example, a school-based health center recently implemented an electronic health record into practice. The staff was split among Generation X, Y, and Baby Boomers. The nurse leader of the school-based health center used a learned or sophisticated management style that promoted a culture of teamwork and collaboration that builds on team members’ strengths. The Generation Y staff felt the most comfortable implementing culturally competent questions into the intake questionnaire and training the others, including clinical mentors, on the new software. The Generation Y staff felt valued and supported by their colleagues and mentors in this successful implementation. The staff at the school-based health center demonstrated that accommodating and respecting generational talents and recognizing achievements resulted in successfully implementing a workplace change. In turn, the new electronic health record project maximized worker engagement and nourished retention through meaningful contributions to the workplace environment. One could also utilize the ACORN model to exemplify cultural and racial diversity. The tenets are the same: treat everyone respectfully and value others’ perspectives.

Conclusion

Nurses in school health services should expect the nursing workforce to be age-diverse for years. The diversity and richness of a multigenerational nursing workforce add strength and a fresh perspective to the nursing team. All members’ voices should be appreciated, and contributions should be encouraged. In today’s highly competitive healthcare market, we need to embrace these unique differences and consider the exceptional characteristics of each generation. Nursing and administrative leaders need to be aware of these characteristics to understand what is essential to a fulfilling career for each generational cohort, no matter the area of nursing expertise. Leaders must respect each cohort’s values to embrace a unified nursing workforce.

Authors

Ellen M. McCabe, PhD, PNP-BC, RN, FNASN
Email: em26@nyu.edu
ORCID ID:

Ellen M. McCabe, PhD, PNP-BC, RN, FNASN is a clinical assistant professor at NYU Rory Meyers College of Nursing. As a recognized leader in promoting equitable school health services, she researches chronic illness management in schools and the provision of school nursing services. Her scholarship embraces public health, children’s mental health, and school health policies. She has taught at the graduate and undergraduate level and continues to practice clinically. Before her academic posts, she began her career as a pediatric nurse at the Children’s Hospital of Philadelphia.

Robin Cogan, MEd, RN, NCSN, FNASN, FAAN
Email: robin.cogan@rutgers.edu
ORCID ID:

Robin Cogan, MEd, RN, NCSN, FNASN, FAAN is a Nationally Certified School Nurse (NCSN) in her 22nd year as a New Jersey school nurse in the Camden City School District. Robin is the New Jersey State School Nurses Association Director to the National Association of School Nurses. She is proud to be a Johnson & Johnson School Health Leadership Fellow and past program mentor. She serves as faculty in the School Nurse Certificate Program at Rutgers University-Camden School of Nursing. Robin writes a popular blog called The Relentless School Nurse. Her extensive work in school nursing was included as a case study in the National Academies of Medicine Future of Nursing 2030 report. Robin also writes a monthly column in My American Nurse, the official journal of the American Nurses Association.

Beth Jameson, PhD, RN, CNL, FNASN
Email: beth.jameson@shu.edu
ORCID ID:

Beth Jameson, PhD, RN, CNL, FNASN, received a PhD in Nursing Science from Rutgers, The State University of New Jersey, and works as an Assistant Professor at Seton Hall University. Dr. Jameson is passionate about public health nursing and addressing the needs of vulnerable children. Dr. Jameson is active in regional and national professional nursing organizations, including NASN, where she is a national presenter on the National Association of School Nurses (NASN) Focus on the Framework™: Quality Improvement. Her current research projects include investigating school health services gaps in care, school nurse workload, and understanding school nurse staffing relationships to student health and education outcomes. She is a founding member and advisor of the Center for School Health Innovation and Quality.