In line with the spread of the Covid-19 and the need to a rapid organization of the medical staff, co-existing of 4 generation of nurses were required to produce cooperation and work simultaneously in the workplace. Although differences between generations can lead tense, conflict and inefficiency, it is crucial for team collaboration to overcome crisis events. The purpose of this research was to present the potential generational gap of the Generation X and generation Y in the workplace and its link to self-efficacy, motives to choose the nursing profession, work values, job satisfaction, burnout and turnover intentions among 150 primary care nurses in Israel during the Covid-19 era. Research data was collected from July 2020 to January 2021. The study used questionnaires match the research variables and was approved by the nursing management of the primary health care organization. Research findings indicate more self-efficacy among Generation X. Significant differences were higher among Generation Y in the level of extrinsic factors affecting the choice of nursing as a career, in work values in the level of achievement ant transparency, in the level of burnout and in turnover intentions. The research emphasizes the gaps between generations and reflects the importance of the workplace to promote successful strategies for each generation. It is crucial for the workplace to be aware of the generational differences especially on emergency times in order to bridge and create a positive working culture, which will ensure quality and productivity alongside satisfaction, less burnout and more stability.
Many countries address today the human capital crisis in the health system. This crisis pertains to dimensions of availability, accessibility, and quality and caregiver staff efficiency. This crisis occurs alongside global constraints, such as: aging population, rising chronic morbidity, rising demand for health services in developed countries, accelerated development of medical technologies, migration of medical personnel and a global trend to reduce health inequalities.
Alongside health care issues as described above, the intergenerational issue meets workplaces in all aspects - from how new employees are recruited, to how they meet the different needs of working people, and how technologies are used within the organization.
Nowadays there are coexisting more generations than ever before at the workplace. New generations are entering the nursing workforce and address intergenerational characteristics - employment variety and professional development, wages, working conditions and standards, employee mobility between the public and private sectors and staff retention in the public healthcare system.
Furthermore, in line with the spread of the Covid-19 epidemic all over the world and a need to a rapid preparation of the medical staff, these co-existing of 4 generation of nurses were required to organize, produce cooperation and work simultaneously between all parties in the workplace. Under working conditions of a worldwide health crisis, feeling of burnout and intention to leave were appeared alongside a true sense of mission.
Generation in the nursing workplace
The current workplace presents significant generation gap which is larger than ever and thus set a great challenge for employers. This outstanding dynamic has brought the generation disparity into the public eye hence the need of different generations to coexist and collaborate (Akhavan Sarraf, 2019; Mahoney, 2015). Though generation gap is not a new phenomenon, today's workplace displays disparity which is greater than ever and thus poses a great challenge for employers. In the nursing vocation this is crucial because differences between generations can lead tense, conflict and inefficiency (Hu et al., 2004).
The current study focuses on the 2 more recent generations comprising most of the workforce in 2021; Generation X and Generation Y.
Generation X was born between the early - mid 60's to late 70s'. As children in the 1970s and 1980s, a time of shifting societal values reflected by increasing divorce rates and enlarged maternal participation in the workforce. Growing up in families in which both parents worked outside the home, led Xers to develop a sense of individualism and independence.
In the workplace Gen Xers are skeptical to authority figures and are accountable for establishing the work-life balance concept. Born in a time of declining population growth, this generation of workers holds strong technical skills and possesses greater independence than the prior generations (Akhavan Sarraf, 2019).
In the Israeli context, some Generation X members are descendant of the generation of Holocaust survivors. While the parenting characteristics of Holocaust survivors were protective parenting with problematic attachment-separation relationships (Kellermann, 2001), Generation X parenting tended to be less authoritarian and more parental permissive (Yaffe, 2017).
The latest generational cohort is Generation Y, which includes young adults born last two decades of the 20th century.
Generation Y have grown up in the digital age. They exhibit larger familiarity than previous generations with communication, media, and digital technologies. This is why they are sometimes termed digital natives (Prensky, 2001). These digital natives were born into a wired world, enabling them to connect and be connected to friends and communities.
From a workforce perspective, they appreciate work–life balance, and peers relations. Their ideal workplace involves variety, mentorship, and a continuing education. They are likely to challenge conventional norms and authority. At the same time they look for direction and leadership and are concerned with getting respect and recognition from peers (Gursoy et al., 2008).
In the Israeli context, in the postmodern world in which Generation Y were educated, when parents tried to be friends with their children instead of authority figures, and at the same time the other authority figures (teachers, commanders, bosses) lost their authority – was created for the first time in Israeli history, a generation lacking youth rebellion. While previous generations were characterized by a spirit of reform and rebellion to their parents' generation, Generation Y is characterized by conformism and non-risk-taking. The ultra-capitalist and ultra-individualistic environment in which they grew up has led to many Generation Y members present a narcissistic character traits and worldview that advocates maximizing profit and personal benefit, even at the expense of the other (Almog & Almog, 2016).
Generation gaps and study variables
The current study examines the intergenerational differences among primary care nurses and its link to self-efficacy, motivation to choose nursing, work values, the level of satisfaction, turnover intensions and burnout.
A number of recent studies have examined these variables, for example: a recent study examined generational differences in the perception of the importance of organizational values among nurses and physicians working in both hospitals and outpatient clinics in Israel. The sample included 515 nurses (a total of 603) from 11 hospitals and community services across Israel. Participants filled in a self-administered questionnaire rating the perceived importance of 20 organizational values, such as leadership, risk-taking, competition, power, and collaboration. Findings showed that nurses scored efficiency, assertiveness, risk-taking, power, and marketing higher than physicians. The study exposed significant differences in work values between generations. Generation X and generation Y employees considered work as less central to their lives, value time off, and pursue more freedom and work–life balance.
Generation X appreciated autonomy, desired promotion and looked for new work opportunities. Most studies found that the younger the generation, to which the workers belonged, the more highly they valued variety and economic revenue in and from their work lives. Generation Y has been found to be significantly different in its search of independence and autonomy (Cennamo & Gardner, 2008; Gibson et al., 2009; Jurkiewicz, 2000; McNeese-Smith & Crook, 2003; Seipert & Baghurst, 2014; Smola & Sutton, 2002).
Cetinkaya et al. (2017) explored burnout levels of nurses in different generations. Survey included 144 nurses who filled in Maslach Burnout Inventory and represented Generations X and Y. Findings showed that burnout levels were moderate in both groups. Moreover, no significant differences were found between groups (Cetinkaya et al., 2017).
As to turnover predictors, members of Generation X are less likely to maintain a job with no growth potential (Apostolidis & Polifroni, 2006). Similarly, growth opportunities are highly valued by X-ers and lack of them is a turnover predictor (Asuncion, 2013). For Generation Y, perceptions of recognition were the only significant predictor to turnover indicating that recognition is most valued by this generation (Asuncion, 2013).
The effect of Covid-19
In an era of a worldwide epidemic, some of the recent studies regarding nurses, focused on burnout as deriving from the pandemic.
Jalili et al. (2020) assessed the prevalence of burnout among healthcare professionals in a cross sectional study. The results demonstrated 326 persons (53.0%) experienced high levels of burnout. These participants treated Covid-19 patients. Moreover, younger age and female gender were predisposing factors for burnout. Also, the level of burnout varied significantly by site of practice and job category. Authors conclude that Burnout is prevalent among healthcare workers caring for Covid-19 patients (Jalili et al., 2020)
In a multinational cross-sectional study healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaires evaluating safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Results showed that 2,364 of 3,537 healthcare workers (67%) were found as experiencing burnout, 701 (20%) for anxiety, and 389 (11%) for depression.
Significant predictors of burnout included patient-facing roles, anxiety and depression. Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Findings indicate an association between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers (Denning, Teng, Tan, et al., 2021).
Finally, an Egyptian study assessed occupational stress, job satisfaction, and intent to leave among nurses treating supposed Covid-19 patients. A comparative cross-sectional study was conducted among 210 nurses. Assessment was done through online questionnaire. Stress levels were high and comprising from 60.5% to 75.2% of the nurses' samples. High prevalence was also to the following stressors: workload (98.6%), dealing with death and dying (96.7%), fears (95.7%) and exposure to infection risk (97.6%). Low satisfaction level was reported from around half of the nurses (Said & El-Shafei, 2021).
Authors conclude that almost all work-related physical, psychological, and social stressors increased among nurses during the pandemic. The Covid-19 pandemic added an extra burden on this already stressful job. This highly stressful work environment resulted in job dissatisfaction with tendency to leave job in the future (Said & El-Shafei, 2021). Thus, support interventions are needed among nurses in order to relieve burnout and prevent loss from the nursing workforce (Denning, Teng, Tan, et al., 2021).
To sum it up, this review introduces the theoretical origins of the generation concept and describes the characteristics of both Generation X and Generation Y in general and in the workplace in particular. Also, this review highlights the Israeli context and refers to the covid-19 pandemic's impact on nursing as the pandemic is integral to the work environment of the current study.
The goals of the study were to examine intergenerational differences on two main groups (Generation X and generation Y) among 150 primary care nurses in Israel. In light of the outbreak of the plague of Covid-19, the study examined the research variables in a period of broad national crisis.
Research questions were:
- Whether significant differences would be found between the two study groups in the level of self-efficacy, motivation to choose nursing, work value, satisfaction, turnover intensions and burnout
- Whether significant correlations would be found between the level of self-efficacy, motivation to choose nursing and work values and the level of satisfaction, turnover intensions and burnout among the two study groups of primary care nurses
- Whether the socio-demographic characteristics contribute significantly to the explained variance of the level of self-efficacy, motivation to choose nursing, work value, satisfaction, turnover intensions and burnout
Purpose of the Study
The purpose of this study is to present the potential generational gap and its link to self-efficacy, motives to choose the nursing profession, work values, job satisfaction, burnout and turnover intentions among primary care nurses in Israel during the Covid-19 era in order to identify the needs of each generation based on characteristics identified and develop a suitable organizational management culture strategy for each generation.
This article highlights the Israeli context including the unique events under a worldwide epidemic and its context to research parameters.
- This research will present novelty and shed light on intergenerational relationships in the primary health care services workplace and address the diversity and intergenerational gap between nursing employees.
The research will contribute to develop meaningful professional nursing environment in the future to come by creating organizational strategies tailored to the different generations of the 21st century characterized by a technology-rich environment and complex medical conditions and implies on the trend of a social behavior in the time of a worldwide health crisis
Research Population Profile
In Israel, there are four main generations of nurses in the workforce: baby boomers, Generation X, Generation Y and Generation Z now joining the employment market.
As of 2020, there were 74,298 certified nurses in Israel, 79% of them were up to age 67. 42% of all nurses are up to age 45, the average age is 42.
Recent report from 2018, that described characteristics of the nursing profession in Israel, showed that the relative size of the group of youngest nurses (age up to 30), was 12%, smaller than the size of the oldest age group (age up to 67%) – 15%.
The two largest age groups were age of 30-44 (32%), age of 45-54 (21%) and age of 55-66 (19%) (Israeli Ministry of Health, 2020).
The target population in this study was the primary care nurses due to accessibility and personal interest. The sample size was selected as a representative sample of the entire population of nurses, thus the study population was held on 150 Generation X (n=75) and Generation Y (n=75) primary care nurses.
Research data was collected from July 2020 to January 2021. The study used selected questionnaires match the research variables.
Participants were asked to sign an informed consent form stating they have been given explanations about the research and agreed to take part in it. This research was approved by the nursing management in the community. Participants' anonymity and confidentiality was guaranteed and identifying details were safeguarded by the researcher.
In order to examine research questions, One-way MANOVA, Pearson correlation and Multiple Regression were used.
Socio demographic findings showed that 8.6% of the sample are males (n=13) and 91.4% are females (n=137). Most of the participants are Jewish (92.6%), Secular (73.3%), were born in Israel (67.3%), are married or in a relationship (64%), live in the center of Israel (83.3%) and have a Bachelor’s degree (52%).
The internal consistency of Cronbach’s Alpha was 0.7 or higher for all research variables.
Research findings indicate higher Self-efficacy among Generation X vs. Generation Y (M = 34.88, SD=3.81 vs M = 33.59, SD = 3.93). Significant differences were higher among Generation Y in the level of extrinsic factors affecting the choice of nursing as a career (figure 1) and in work values in the level of achievement and transparency (figure 2). No significant differences between the two generations were found in the level of Job Satisfaction. The level of turnover intensions among generation Y primary care nurses (M = 2.92, SD = 0.60) was significantly higher compared to generation X primary care nurses (M = 2.52, SD = 0.80). The level of burnout (in the level of cynicism) was also significantly higher among generation Y (figure 3).
The research emphasizes the gaps between generations and reflects the importance of the workplace to promote successful strategies for each generation. In the context of our current era, the corona plague has highlighted the need for medical staff in light of the existing global shortage of nurses per capita. Alongside this, factors such as satisfaction, burnout and tendency to leave are intensified during this complex period.
It is crucial for the workplace to be aware of the generational differences especially on emergency times in order to bridge and create a positive working culture, which will ensure quality and productivity alongside satisfaction, less burnout and more stability.
It is important to note that a future research on generations Z will be required to assess the late effect of the epidemic in the workplace and its influences on research parameters such as motives to choose nursing career or self-efficacy.
To conclude, it can be stated that the presence of employees from different generations at all levels of an organization and especially in a time of a worldwide health crisis, has been found to be a crucial factor in understanding their similarities and differences so as to exploit the diversity, creativity and energy of these employees so as to reach better results. It appears that further empirical studies are require to present behaviour characteristics at work, so as to demonstrate the characteristics of the newer generation to the previous ones.
This article was written as part of research seeking to examine the generation gaps in nursing in Israel. The article seeks to narrow the gap in knowledge regarding research variables in a time of a worldwide crisis.
The researcher is a PHD student in the University of ALEXANDRU IOAN CUZA, IAȘI, Faculty of Philosophy and Social-Political Sciences.
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23 March 2022
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Chen, O., & Balahur, D. (2022). Generations And The Nursing Profession During Covid-19 Epidemic. In I. Albulescu, & C. Stan (Eds.), Education, Reflection, Development - ERD 2021, vol 2. European Proceedings of Educational Sciences (pp. 180-188). European Publisher. https://doi.org/10.15405/epes.22032.17