The nursing field is at a generational crossroads, with millennials and Generation Z increasingly making up a larger share of the nursing workforce—and it turns out their professional priorities and expectations differ from past generations in a few key ways, according to a new HCA Healthcare survey.

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Why HCA did the survey

Jane Englebright, SVP and chief nurse executive at HCA, said that HCA conducted the survey to better understand the newest generations of RNs and the factors influencing their career choices.  

"We went from the millennials and the Gen Z being the minority in our employee population, particularly our nursing group, to now they're the majority," Englebright said.

For the survey, the health system partnered with the Center for Generational Kinetics to survey a nationally representative sample of 1,000 millennial RNs—ages 23 to 39—and 250 Gen Z RNs—ages 18 to 22.

What matters to millennial and Gen Z nurses?

When searching for new jobs, the survey revealed that millennial and Gen Z RNs value companies that have a reputation for having a positive work culture—and they assess that culture primarily through online resources, such as employee rating and review websites and employee testimonials on companies' website and social media channels.

According to the survey, respondents identified colleague relationships (44%) as the most important factor in creating a positive work environment for RNs. Several other factors were close behind, including:

• Flexible scheduling, cited by 43% of respondents;
• The opportunity for career advancement, cited by 43% of respondents;
• Communication and the ability to make clinical decisions, cited by 42% of respondents;
• Basic needs, such as breaks, meals, and water, cited by 41% of respondents;
• Facilities, equipment, and technology, cited by 41% of respondents; and
• Workload, such as patient-nurse ratio, cited by 39% of respondents.

But when it comes to career advancement, HCA discovered that, for millennial and Gen Z RNs, career advancement didn't always mean vertical growth. In fact, 28% of RNs surveyed considered moving to a new department or floor as valuable career progress—the same percentage that identified taking on more responsibility.

The survey also looked into what organizational strategies help RNs feel supported at work and found that the No. 1 answer—cited by 49% of RNs surveyed—was having a flexible schedule, followed by having an avenue to share their ideas (47%) and knowing how they can advance in their careers (46%).

When asked which support system means the most to them, 57% of RNs said they value the support they receive through their team. Specifically, 29% of RNs surveyed cited a having a consistent team as the support system that meant the most to them, while 28% cited having friendships with coworkers outside of work.  

How HCA plans to support the next generation of RNs

In an interview with HealthLeaders Media, HCA's Englebright said that the survey findings reinforced several things HCA believed they knew, but added there were some findings that they "didn't expect."

For instance, "We found out [RNs] have high expectations for their own performance, and they have really high expectations from us as an employer," she said.

While millennial and Gen Z RNs are "really focused on their own personal development," the way they view personal and professional development is different from other generations, according to Englebright. "They want to grow and develop and learn new things, but they want to do that at a little bit faster pace than what we have seen in the past," she said.

One key findings that Englebright said jumped out at her team was millennial and Gen Z RNs' views on professional development. They view "any opportunity to learn and gain new skills and knowledge as progression," she said. "[M]ovement [in the organization] and doing something new and different feels like progression to them, whereas traditionally we thought if you weren't getting a promotion or moving into management, it wasn't progression."

Given those findings, Englebright said HCA is placing a greater emphasis on career advancement moving forward. She said HCA is currently adding "clinical advancement centers" to "provide that education, growth, and retraining opportunities throughout the [nurse's] life cycle."

"And we're exploring how we can make it easier for nurses to move around inside HCA Healthcare," she added. "They know what's available in their hospital, but they may not know what's available in the other 180 hospitals in the system. That could offer them …whatever it is they're looking for in terms of the next challenge in their career" (Thew, HealthLeaders Media, 2/7; HCA/The Center for Generational Kinetics survey, accessed 2/10).