Generational diversity in nursing practice environments – scoping review

The studies analyzed identified a lack of consistency in the chronology of the generations, which relates to the diversity of time limits for each generational cohort. Gen Z, the youngest generation, reveals the greatest discrepancies in its time limits. Also, individuals born at the time limits of each generation, referred to in the literature as cuspers, combine characteristics of two generational groups [41]. Both these aspects are seen as limitations, making comparisons of the findings more difficult. Leiter et al. (2010) even eliminated nurses identified as cuspers from their study, to accentuate the distinctive characteristics of each generational cohort.

Studies show that the generational factor may represent a dividing point in behaviors and attitudes toward work. Social changes to the 20th-century model of society, built around the value and meaning attributed to work, have become increasingly clear. Today, there are new ways of understanding the social representations of work, which are becoming less central to people’s lives, in contrast to the attitudes towards work that older generations usually reveal. In this matter, while flexible and insecure work relations are becoming more frequent [45], several authors [7, 10, 11, 19, 21‐25, 27‐30, 35] stated that work-life balance is a fundamental aspect, especially for younger generations. As younger generations tend to dedicate more time to family or friends and pursue personal aspirations, obtaining flexibility from their leaders to better achieve work-life balance, could be an important strategy to make them feel respected and satisfied [46]. Likewise, the Delloite Global report (2024) also highlights the importance of reconciling work and family life for younger generations, particularly Gen Y and Gen Z, which stand as their main priority when choosing a workplace [47].

One of the difficulties pointed out by the coexistence of different generations in professional practice environments relates to communication and conflicts [9, 10] and, although these are important aspects, it was not clear from the findings that there’s an explicit contribution to conflicts or miscommunications in multigenerational workplaces. Instead, the results in this review indicated that, according to nurses’ perceptions, the generational diversity of teams does not seem to be a factor that increases conflicts in the workplace [33]. Some authors have mentioned the huge benefits of teamwork in generational diverse practice environments [33, 37]. So, although appropriate importance should be placed on avoiding generational conflicts in the workplace, the relevance given to this aspect should rather be placed on managing an age-diverse workforce of nurses using strategies adapted to different professional characteristics and expectations [33].

Leadership plays a central role in health organizations, as an essential factor guaranteeing the success of strategic management [48, 49]. In this category, generational differences in nurses’ perceptions and expectations of leaders’ performance became clearer. Findings show a transition from more hierarchical structures, preferred by Veterans, to increasingly horizontal organizational structures with a higher emphasis on collaborative management, preferred by younger generations. Also, nurses from younger generations stated their preference for a mentor as a leader, who promotes feedback and guidance [7, 23, 34]. Considering that younger generations appreciate participating in decision-making regarding organizational issues, nurse managers should be aware of these characteristics and promote their involvement in decisions as a useful strategy to enhance job satisfaction [46]. In addition, it is important to consider their preference for greater support and feedback and the expectation of more frequent communication with their leaders compared to previous generations to promote greater job satisfaction and commitment [46].

The global shortage of nurses, largely due to financial constraints, has contributed to unfavorable working environments, creating additional difficulties for health organizations which struggled even more with nurse retention issues and increased intent to leave [49]. In recent years, engagement, organizational commitment, turnover, intent to leave, and retention have become central areas for health organizations, finding increased difficulty in attracting and retaining nurses, especially from younger generations. This review also showed the growing concern for more research and strategies to retain nurses in healthcare organizations. Older generations demonstrated higher levels of engagement and organizational commitment, job satisfaction, and a lower tendency to turnover than younger generations. This seems to be anchored in higher relevance attributed to work given by older generations, such as Veterans and Baby Boomers [21, 28, 29]. In contrast, in younger generations, job insecurity perception, largely caused by precarity and increased devaluation of salaries, plays a major role in the relevance attributed to the relationship between nurses and health organizations [9]. Despite the obvious importance of these aspects, there is still a lack of acknowledgment by health organizations in their valorization, contributing to less favorable working conditions, and influencing the quality and safety of nursing care [50‐52]. Given the preferences of different generational groups, administrators and nurse managers must adopt strategies that promote not only the retention of younger generations but also the job satisfaction, organizational commitment, and engagement of older and younger generations. Intergenerational collaboration is therefore fundamental, so that younger generational groups are willing to take on the shared responsibility of shaping the future of the profession through leadership, autonomy, a sense of independence, and better professional opportunities, but also to bridge the gap in knowledge and experience between older and younger generations while consolidating organizational values [22].

Health and organizational policies that effectively aim to promote more favorable practice environments should be based on building better working conditions (nurse staffing, adequate resources, and leadership) [27], across all generations and enabling nurses to provide safe and quality care, recognizing their economic value amongst health professionals [7].

Nonetheless, there is a growing disruption in how organizations adjust to changes in health policies. The challenge lies in promoting an inclusive environment [53, 54], integrating the strengths of each professional and each generational cohort, and using these characteristics to develop cohesive multigenerational teams focused on teamwork and delivering quality care [29]. Therefore, health organizations and leaders can be decisive in promoting inclusive practice environments, by possessing a solid knowledge of each nurse generation’s characteristics, supporting younger generations to improve healthcare organizations, and keeping older generations’ experienced nurses committed to quality nursing care [27, 33, 40].

Nurse managers must understand that individuals from different generational groups have different sets of values and, therefore, it is essential to create synergies to harmoniously involve intergenerational groups in the workplace [22]. As more nurses from Gen Z are included in the nursing workforce and work alongside the most senior nurses, many nurse managers are learning that a one-size-fits-all management style simply does not exist. Each generation now working side-by-side brings unique viewpoints to the table and lets generation-specific values guide professional practice. Incorporating different motivational techniques into nurse management, adapted to generational characteristics should be a good incentive for nurses from different generations (For example, younger generations may appreciate more time off, while Veterans or Baby Boomers may appreciate a financial reward and public recognition) [46].

It is essential to create a positive and inviting culture that combines the best qualities of each generation. Baby Boomers are clinical experts and magnificent mentors. Gen X nurses are creative, willing to modernize care delivery models, and should be encouraged to adjust their working environments to new challenges. Gen Y members are technologically savvy and should be involved in teamwork, recognizing their skills. Finally, Gen Z is very dynamic, learning, working, communicating, and creating opportunities in a very different way from previous generations, leading organizations to redesign workplaces to meet their needs [7, 29].