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COVID-19: how different generations can collaborate to make the nurse workforce stronger

Nurse returners and students joining the emergency register bring unique skills and experience

  • Older nurses who have worked through different care models over the years are likely to be more adaptable and possess more general skills
  • Nursing students have up-to-date clinical knowledge and greater understanding of digital technology
  • Embrace the diversity of knowledge and experience and what each nurse can bring 

Picture: Daniel Mitchell


Elaine Maxwell 

As a nurse who trained in the 1970s and had left the register, Elaine Maxwell is quite clear about what she can – and cannot – contribute in the current COVID-19 emergency.

She brings a calm head, hands-on experience of different models of care, and an active memory that includes experience of nursing in emergency situations, such as the 2005 London bombings.

Sam Turner, on the other hand, a third-year nursing student at Manchester Metropolitan University, is equally sure about what he brings, including up-to-date clinical skills and an enthusiasm (tinged by understandable apprehension) to work on the front line.

They come from different nursing generations, but they contribute the same thing: a willingness to get involve, to do their bit – whatever that might take.

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Using the benefits of experience

‘First and foremost, I can bring the ability to look at the information calmly and rationally,’ says Dr Maxwell, a clinical adviser to the National Institute for Health Research (NIHR) and a former director of nursing. She has just returned to the register to work at John Radcliffe Hospital in Oxford.

‘We need to be respectful of each other but also realise each journey has contributed to making nursing what it is today’

Sam Turner, student at Manchester Metropolitan University

‘I can sit down with nurses and say, “hang on, what’s the evidence around this?” And I can help with planning and preparations. So today I was asking what the model would look like if you ended up with 15 patients to one RN (registered nurse). How are you going to manage that?

‘Now, I trained when you were left in charge of a ward when you were in third year – I’m not saying that was good, but I’ve got a whole load of experience, so can say that if you’re in that sort of position, maybe that’s how you should manage it.’

Cooperation and conflict between different age groups

 John Houlihan
Sam Turner. Picture: John Houlihan

Today, the nursing register is swelling with nurses who had recently retired or left the profession, and with students yet to complete their training. In other words, nurses beyond either of the ‘ends’ of the usual generational spectrum are shoring up the workforce and helping services to cope under what are expected to be unprecedented pressures.

While cooperation is obviously the ideal, there is a body of research that suggests conflict between different generations of nurses. This is something Mr Turner has experienced: being a strong advocate of nursing as an all-degree profession, he has found himself taken to task for expressing his views.

‘An older nurse recently asked if that meant I thought all older nurses were obsolete,’ he says, ruefully. ‘I said no – but you should accept that nursing is now a degree profession; it’s never going to go back. You can’t turn the clock back 20 years. It’s now fixed as a degree profession, but some people are still nostalgic for the fact it wasn’t.

‘We need to be respectful of each other but also realise each journey has contributed to making nursing what it is today.’

Avoid generalisations about age

Dr Maxwell trained pre-Project 2000, which introduced reforms that turned nursing education over to higher education –  but she went on to do a PhD later in her career. She is unimpressed by generalisations made on the basis of individuals’ age, be they baby boomers (like her) or generations X, Y or Z (see box below).

‘There is no science behind it,’ she says. ‘The idea you can categorise people according to the decade of their birth is about as useful as horoscopes; it’s ridiculous. What I don’t like about that classification is it implies it’s in your genes and can’t be changed.

‘What I would say is that people who were born later than me have been socialised differently to expect different things, but that can be changed.’

She points out that nursing was different in the 1980s and 1990s – but that ‘the world didn’t end’ and she and her colleagues were not struck off for working in a way that would not be seen as ‘gold standard’ today.

‘It is possible to do things differently from how you do them now and it will be okay,’ she says. ‘One of the reasons I can say that is that 40 years ago when I was a staff nurse, I was the only staff nurse on the shift, and I had to delegate work to students or auxiliaries, and I’m quite comfortable about how to do that in a way that maybe people in wards with a high number of staff nurses aren’t used to. There’s a whole lot of support about how to work differently that my generation can bring.’

What may (or may not) make different generations tick

A 2015 Health Education England report, Mind the Gap, looked at the needs of newly qualified nurses and midwives in the workplace, and used generational classifications to try to explain what makes different categories of nurses tick. It warned that the descriptions were based on stereotypes, and should be seen only as a general guide.

 iStockGeneration Z (born 1995-2010) The digital native

Expects to keep in touch, values connectivity, does not want to be forced to fit into a traditional work environment, values transparency, personal freedom and flexibility, and expects to be listened to and acknowledged.

 

 iStockGeneration Y (born 1980-1994) The millennial

Has high career expectations, needs frequent feedback and a good work-life balance, values a sense of community in the workplace, will change jobs if their needs are not met, needs mentorship, coaching and reassurance, and relies on support and feedback.

 

 iStockGeneration X (born 1965-1979) The latchkey kid

Likes structure and direction, is practical and independent, works smarter, not harder, does not like to be micromanaged, or to have their time wasted, is technology-literate but doesn’t live and breathe it, has high expectations, and can innovate and respond well to change.

 

 iStockBaby boomer (born 1946-1964) The post-war child

Wants to make a difference, is motivated, hard-working and team-oriented, takes risks and likes excitement, will challenge authority, has high expectations, likes to be liked and needed, wants recognition for achievements, is driven and experienced, and makes up 25% of the NHS workforce.

Source: NHS Employers

 

Front-line clinical skills

What do today’s young and newly qualified nurses have to teach Dr Maxwell and other retired nurses coming back into the workforce?

‘They have the up-to-date clinical skills – they need to be the clinical leaders of a team,’ Dr Maxwell says. ‘They should do the patient assessments and write the care plans, because I’m not competent to do that, although I can deliver the care plan.

‘The older generation has seen different models of care, so might be more flexible about how to deliver that care and might have some ideas about how to deliver that care when there are fewer resources available.

‘It’s not that I don’t think the younger people aren’t pragmatic – it’s just that they only know one way of doing it, whereas if you’ve done the job for 40 years, you’ve seen various models of service delivery.’

Dr Maxwell wants to see nurses of different generations supporting each other in practical ways, particularly in the current pandemic.

‘There are a lot of current and retired nurses who have co-morbidities and can’t work on the front line – even people who are younger than me. We have to think about how we can harness these people’s skills and expertise.

‘We live in the most technologically connected way we’ve ever had in history, so if we’ve got these young people at the front line, feeling scared and not sure what to do, there must be a way they can be buddied up to people who can’t actually come in [to the workplace].

‘Many people have retired and are willing to come back for this period, but it’s about deploying their skills and identifying where they want to work and what they want to do’

Judith Graham, Rotherham Doncaster and South Humber NHS Foundation Trust

‘If I was 24 and on the ward and everyone else was off sick, if I had a wise person I could ring up and talk to if I felt it was all going wrong, and I didn’t know what to do, they could go: “You can cope. What’s the problem? Why don’t you do this?” And at the end of my shift, someone I could debrief to – on a one-to-one basis.’

 Alamy
When nurses from different generations cooperate they take advantage of their
sometimes distinct skills. Picture: Alamy

Diversity of roles and skills

As well as being a challenge for the individuals involved, the current pandemic also means managers are having to think about new ways of working and how to support its new workforce.

Judith Graham, a specialist mental health nurse and psychotherapist by background, is deputy director for organisational learning at Rotherham Doncaster and South Humber NHS Foundation Trust. She believes there are many positives to be gained from intergenerational effort. For those returning to practice, it is about looking at diversity and what they bring.

‘Many people have retired and are absolutely willing to come back for this period, but it’s about deploying their skills and identifying where they want to work and what they want to do,’ she says.

‘For some people, because of their maturity, or because of co-morbid issues, it might be they work in a training arm, upskilling people rapidly to go into more critical care or hospice services. But it can be lots of other things.’

She points out that nurses from previous generations would be more likely to have been trained in more general skills than today, as specialisation now happens earlier. Some of these skills – such as caring for the dying patient – are particularly pertinent to the coronavirus pandemic, she says.

Supporting students who join the register

Dr Graham's trust is developing systems to ensure students who take up the offer to become temporary registrants are supported, which includes having practice mentors to work alongside them. But she points out they will often have something extra to offer their older colleagues, too.

‘I don’t want to stereotype because there are some tech-savvy silver surfers out there, but our younger generations are helping some of our more mature generations, who maybe haven’t used as much digital technology, video conferencing and all the other things. They’re helping them to do that so they can help patients in different ways,’ she says.

Mr Turner – who expects to be deployed as a nurse in May, says that the nursing response to COVID-19 is an opportunity to show the world the profession has a vital role to play in global health.

‘It doesn’t matter what your background is, education-wise, at whatever point you are. Whether you’ve just retired and are coming back or you’re a student coming in early,’ he says. ‘You can still make a difference.’

Lessons for practice

  • Understand that nurses, whatever their generation, want to do their best for patients
  • All nurses have something to offer, regardless of age
  • Newly qualified nurses bring up-to-date clinical skills; older nurses bring experience and a valuable memory bank of different ways of doing things
  • It is not possible to generalise about a nurse on the basis of age
  • Nurses across the generations can and should support each other

 

Jennifer Trueland is a health journalist
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