Understanding Millennial Nurses in Clinical Practice

Understanding Millennial Nurses in Clinical Practice

Dr. Medel O. Cabalsa¹, Rosemarie Vista RN MAN², Gemma A. Paralias RN, RM^3
1Asst. Professor, College of Nursing, Riyadh Elm University, Riyadh Saudi Arabia
²Clinical Instructor, College of Nursing, Riyadh Elm University, Riyadh Saudi Arabia
³Staff Nurse, Qassim University Medical City, Buraidah City, Saudi Arabia

 ABSTARCT

The study examined the attitudes and behaviors of millennial nurses towards their self, work and profession as evaluated by themselves and their heads in Riyadh hospitals. The research design used was sequential-explanatory mixed method research. The population comprised of millennial staff nurses in Riyadh tertiary hospitals. Two hundred nurses were sampled from tertiary hospitals selected in Riyadh Region. Questionnaires and semi-structured questions were used to collect data for the study. The data collected were analyzed using descriptive and inferential statistics such as frequency and percentages, and weighted mean while the hypothesis was tested using pearson’s chi square at 0.05 level of significance. The result showed that the millennial nurses value the privacy with personal, colleague and patient information; they tend to look for regular tenure in the nursing workplace, and believe in the power of education for professional growth. The findings also shown that nurses self-adheres to the standards of the profession for self-development; complete assigned tasks, but often missed other information uncovered while performing the task and have an opportunity to learn from mistakes made without patient consequences. There is a significant difference on the attitudes and behavior of millennial nurses based on the evaluation of respondents. The communication barrier, culture of homogeneity and the knowledge and skills gap were the identified issues and challenges faced by millennial nurses. Based on the findings, it is recommended that the human resource department take in consideration the attitude and behavior of millennial nurses in recruitment, adequacy of the program that focus on clinical competency and conduct training that will develop their generational characteristics towards work.

Keywords: Attitude, Behavior, Clinical Practice, Millennial  nurses.

INTRODUCTION

epresenting the largest population of the workforce, millennial nurses affect the hiring outcomes and workforce planning of current and future employers aspiring to survive and exist as major business entities. Consequently, nursing leaders must address issues leading to the minimization and prevention of costs associated with millennial employee high turnover rate, recruiting efforts, and onboarding.

Among millennial characteristics, they are the on tract to be the most educated generation to date [1]. Their age and their times have created a generation very distinct from other generations. This generation understands the significance, the size that their generation has towards nursing‘s future. It should be noted that they are also needed. For nurses, millennial nurses are highly adaptable, tech savvy, adept at multitasking and therefore are inclined to bore easily. They are progressive thinkers, process new information quickly, embrace change, high standards, and excel at teamwork [2].

Many economists are concerned about large numbers of the most experienced workers in the labor force because of retirement and/or mortality over the next few years, and intensification of global competition for workplace talent [3]. Millennials will have to fill the gaps in the workplace left by the large and ever-growing number of retiring baby boomers. Millennials currently make up approximately 35% of the workforce, and by 2020, it is estimated they will comprise over 40% [4a][4b]. In Saudi Arabia, the millennial population bulge is similar — only slightly larger, making up about 26 percent of the Saudi total. Millennials, along with those from ages 10-24 in Generation Z, make up some 54 percent of all Saudis [5]. Millennials are coming of age, and they are overtaking the workforce with a work culture that is significantly different from the values that the previous generations upheld. How previous generations do not understand the needs of the millennial generation in the current workplace [6].

The context for the workplace expectations and practices that millennials prefer in order to remain long-term with their current employers remain the problem that result to nurses‘ high turnover rates and understaffed. Millennials have less willingness to stay in their current jobs. Half of millennials compared with 60% of non-millennials strongly agree that they plan to be working at their company one year from now [7]. Previous generations with being more concerned about workplace loyalty, long-term retirement benefits, teamwork, and respect for authority and sacrifice, minimizing the frequency with which they switched and changed jobs and careers, unlike millennials [8].

Additionally, the researcher observed that the millennials come with more expectations from their employer and expect that they will with a multitude of rational and profitable reasons to encourage them to stay long-term. With other circumstances such as outstanding training and education, challenging work experience and open and honest working relationship triggered the researcher to explore the millennial nurses. Since the millennial prefers to be mentored, outstanding training education and work with latest technologies yield strategic relationship in the workplace. Thus, the hospital providing millennial-friendly workplaces will increase millennial retention rates and reduce high turnover rates, thus aiding the reduction of costs for businesses [9].

LITERATURE REVIEW

The characteristics and traits of other generations that millennials will encounter within the workforce will be discussed as part of the literature review. Millennials process information and communicate differently than other generations in the workplace. Millennials communicate so differently from previous generations because they are the first generation born in the digital age and grew up with the Internet and social media platforms at their fingertips [6]. The millennial generation has helped expand the use of social media due to constant and continuous interconnectedness to the  Internet  [10].  ―They  embrace  multiple  modes  of  self- expression, and nearly 75% of them have a profile on a social media site‖ [11]. Many baby boomer managers do not understand social media on how it can be leveraged to communicate ideas and win new customers [12].

The millennial generation grew up with less formality and social restraints than the generations before them [11]. The millennial generation has characteristics and traits so different from previous generations that it is imperative to be studied and understood to best understand how to guide them to their full potential in the workplace. They are also the most educated generation; this trend accelerated in recent years because of the demands of a modern, technology-driven workplace [11]. There are many millennials who have a higher education level than their current baby boomer supervisors, and this has become a point of contention between the two generations [13].

Demographers and researchers typically use the early 1980s as starting birth years and the mid-1990s to early 2000s as ending birth years of the Millennials (also known as Generation Y). They are the generational demographic cohort following Generation X. There are no precise dates for when this cohort starts or ends; Millennials are sometimes referred to as “echo boomers” due to a major surge in birth rates in the 1980s and 1990s, and because millennials are often the children of the baby boomers.

The 20th-century trend toward smaller families in developed countries continued, however, the relative impact of the “baby boom echo” was generally less pronounced than the post–World War II baby boom [14].

The millennial generation comprises the majority of learners in the traditional university setting. In the nursing front, nurse educators identify problems developing teaching strategies in education that undergraduate. Millennial nursing students find engaging and meaningful [15]. Although millennial characteristics vary by region, depending on social and economic conditions, the generation is generally marked by an increased use and familiarity with communications, media, and digital technologies. In most parts of the world, their upbringing was marked by an increase in a liberal approach to politics and economics; the effects of this environment are disputed.

Moreover, millennial nurses expect quick access to their leaders and want prompt, and frequent feedback. Unlike previous generations, millennials are drawn to work that they perceive to be meaningful and to work environments that support a work-life balance. Having grown up learning and working in groups, they favor teamwork, collaboration, interdependence and networking. Novice nurses find the first months of work the most difficult. They are acutely aware of missing their clinical instructor and may even contemplate leaving the profession. New graduates have long been labeled as inadequately prepared to transit easily into the workplace. This is not surprising since the new graduate‘s experience is recognized as a time of significant professional adjustment [16]. Millennials are the generation that makes up one-third of the workforce. In nursing, cohesion on the floor or in a practice is crucial to success with patients. Recognizing their abilities, and learning how to both mentor and learn from millennials is necessary for nurses who manage them. Nurses from the baby-boom generation are the ones with the highest leadership positions right now. They prefer communicating and teaching in mentor- style relationships, and like to speak with others face-to-face or over the phone. Millennials like quick communication, since they have grown up with email and text messaging. They are likely to grow frustrated when they have to wait for a response. In addition, they are not really into reading lengthy communication documents, like long instructive emails or PDFs. [17].

Generation Xers is the generation that used technology as a communication method, and while they‘re not as reliant on text or instant messages as millennials, they also don‘t want to wait for lengthy discussion before a decision can be made [18]. However, to facilitate collaboration and a healthy work environment, nurses of all generations must understand the diversity in today‘s workplaces; not just in culture and ethnicity but age as well. Generational differences do not have to result in negativity; positive intergenerational relationships can be formed that benefit all involved [19].

Novice nurses face real challenges when entering the workplace. They are particularly vulnerable to high levels of burnout, increased levels of depersonalization, and lower levels of personal accomplishment than more experienced nurses are. Difficulties for these new members of the profession lead to rising attrition rates and possible marginalization. New programs and approaches are needed in order to engage novice nurses in the profession. This can be done by helping them in managing transition the workplace [20].

Members of Generation Y are digital natives because they have grown up experiencing digital technology and have known it all their lives [21]. Digital natives are ‗native speakers of the digital language of computers, video games and the internet‘. This generation spans 20 years and its older members use a combination of face-to-face communication and computer mediated communication, while its younger members use mainly electronic and digital technologies for interpersonal communication [22].

According to Florida International University, the Generation X started shifting preferences towards an improved work-life balance with a heightened focus on individual advancement, stability, and job satisfaction. Meanwhile, millennials place an emphasis on producing meaningful work, finding a creative outlet, and have a preference for immediate feedback. In the article “Challenges of the Work of the Future,” it is also stressed that millennials working at the knowledge-based jobs very often assume personal responsibility in order to make the most of what they do. As they are not satisfied with remaining for a long period of time at the same job, their career paths become more dynamic and less predictable. Findings also suggest that the introduction of social media has augmented collaborative skills and created a preference for a team-oriented environment [23].

Furthermore, the millennials as well are educated and much better connected. They feel powerful among themselves. They are less religious and are getting married later and having less children when they do. They are just as optimistic as any previous generation. They do not look up to brands, institutions, or figureheads as much. The future, they know, they must build for themselves with their friends and peers. They know they must take control of their own careers. That they must think independently. Lifelong employment is a fairytale for them. It is all about lifelong learning, being on the move, being in control. That is partly because they know that employees who stay with companies longer than two years will be taken for granted and will, on average, get paid 50% less, but because they know that they live in an impermanent, ever-changing digital world [24].

There are several characteristics of millennial nurses. Many of the generational traits attributed to the millennial were influenced by a period of prosperity. Members of this generation came from relatively affluent families and attentive parents who were constantly vigilant and very involved in their rearing [25]. As nurses, they probably participated in-group activities such as sports, lessons, and playgroups. They were raised to love and believe in themselves. They became optimistic and hopeful young adults who developed highly collaborative, creative abilities.

Factors that Affect the Clinical Practice of the Millennial Nurses

Clinical competence is an important outcome in nursing education. Evaluating clinical eligibility and indicating factors affecting it may be helpful in promoting the quality and effectiveness of nursing education. Accordingly, continuous educational development, support from immediate supervisors, level of self- confidence, professional commitment, personal commitment to help or care for others, resource and its management. Patient-nurse ratios are identified factors influencing clinical decision-making practice among nurses. Commitments to ones professional responsibility, ongoing supervision, feedback, authority, autonomy, creating management, patient-nurse ratio, resource, supply (water, patient monitoring machines, transportation beds, space for admission), structure and culture of the health care system, absence of continuous formal and informal professional development, lack of self – confidence and level of knowledge on basics of nursing profession are identified as factors inhibiting clinical decision-making practice among nurses. Nurse Managers have to search for solutions on how to decrease and if possible completely avoid factors that affect clinical decision- making practice and encouraging implementation and utilization of facilitating.

Generational diversity provides a unique quandary for nursing leaders and educators to enlist, orient, and retain nurses. Millennials are the largest cohort since the Baby Boomers and the age group from which the nursing profession will build its future workforce. This study examined the experiences of the new graduate nurse of the millennial generation as they navigate orientation in an acute care setting [26].

Millennials or the new generation of nurses’ desire technology, security, and personal time off. King’s theory of goal attainment provides a framework to assist current students. The use of technological and communication devices is a discourse for students and educators. Nurse educators will need to mentor millennial students as new pioneers in practice. The pioneer millennial generation of students and graduates is entering the profession of nursing. They are adeptly equipped with technological savvy, unabashed confidence, and self-directed goal achievement [27].

Objectives of the Study

• To determine the attitudes and behavior of millennialnurses towards self, work and profession;
• To assess the factors affecting clinical practice of millennial nurse
• To identify the common issues and challenges faced by millennial nurses
• To ascertain the significant a significant difference on the evaluation of attitude and behavior of millennial nurses between themselves and their heads

METHODOLOGY

An explanatory sequential mixed method were utilized to analyzed data gathered for this study. The checklist-type questionnaire was formulated to evaluate the attitude and behavior of the millennial nurses as to self, work and profession as well as the factors affecting their clinical practice. The questionnaire followed a four-point Likert scale type as Strongly Agree, Agree, Disagree and Strongly Disagree. The semi-structured questions were used to collect the narratives from the participants. This study followed the Braun and Clarkes thematic analysis.

A total of two hundred questionnaires were distributed to the millennial nurses and was evaluated by their heads. They were retrieved from the millennial nurses. The semi- structured questions help to extract the common issues or challenges faced by the millennial nurses. Responses were analyzed using descriptive and inferential statistics such as weighted arithmetic mean while the hypothesis was tested using Pearson chi-square test at 0.05 level of significance.

RESULTS

This section intends to discuss the research findings of this study on the attitudes and behavior of millennial nurses.

Table 1: Attitudes of Millennial Nurses Towards their Self as Evaluated by Staff Nurses and their Heads

Table 1 illustrates the attitude of millennial nurses towards their self as evaluated by themselves and their head. The results shows that most of the millennial value privacy within personal, colleague and patient information with weighted mean of 3.70 while both nurses and their heads agreed that effectively communicate with healthcare personnel has the lowest attitude towards with weighted mean of 3.24 and 3.22 respectively.

Table 2: Attitudes of Millennial Nurses Towards Work as Evaluated by Staff Nurses and their Heads.

Table 2 shows the attitudes of millennial nurses towards work as evaluated by staff nurses and their heads. The results shows that millennial nurses wants job security e.g., regular tenure in the nursing workplace. Those staff nurses agreed that have a greater institutional knowledge on rules and regulations in relation to nursing competency standards with weighted mean of 3.19.

Table 3: Attitudes of Millennial Nurses Towards their Profession as Evaluated by Staff Nurses and their Heads

The above table presents the attitudes of Millennial Nurses Towards their Profession as evaluated by staff nurses and their heads. The table reveals that as nursing professional millennial nurses believes in the power of education for professional growth having weighted mean of 3.62 whereas their head perceived that nurses desire to use social media platform and other technological advancement in the clinical practice (WAM 3.60) and with the lowest 3.13 on mistakes in the clinical practice are nothing but more than an opportunity to learn.

Table 4: Behaviors of Millennial Nurses Towards Self as Evaluated by Staff Nurses and their Heads

The table 4 shows the behavior of millennial nurses towards self as evaluated by staff nurses and their heads. It can be inferred from the table that nurses keep adheres to the standards of the profession for self-development (WAM 3.64) whereas their heads perceived them that adhere to ethico-legal considerations when providing safe, quality and professional nursing care.

Table 5: Behaviors of Millennial Nurses Towards Work as Evaluated by Staff Nurses and their Heads

The table 5 shows the behavior of millennial nurses towards work as evaluated by nurses and their heads. The table results shows the millennial nurses and their heads perceived towards work to develop a plan of care from what they synthesize having weighted mean of 3.60 and

3.46. Both millennial nurses and theirs heads agreed largely unable to apply (or were unfamiliar with) critical thinking skills with weighted of 2.73 and 2.69 respectively.

Table 6: Behaviors of Millennial Nurses Towards Profession as Evaluated by Staff Nurses and their Heads

The above table illustrates the behaviors of millennial nurses towards profession as evaluated by nurses and their heads. The table reveals that the millennial nurses perceived themselves in their profession as having an opportunity to learn from the mistakes made without patient consequences, therefore building both the knowledge and confidence of new nurses in the profession (3.61) whereas their heads observed them as exemplify the ethics, morals, responsibility and values for the conduct of the profession in the practice setting.

Table 5: Factors affecting the Clinical Practice of Millennial Nurses

The table 5 shows the factors affecting the clinical practice of millennial nurses. The result shows that the respondents strongly agreed that those factors namely: orientation and training; supervision; organizational climate; nurse conflict were affecting their clinical practice. Nurses strongly agreed that compensation benefits is the main factors affecting them (3.53) followed by adequacy of staffing (3.45) and leadership (3.45). One competency is nurses should perform safe and appropriate care and apply principles of evidenced- based practice [28]. The nurse should apply the principles of positive practice environments in workplace practices and facilitate their establishment in the health sector Nurses should also raise awareness, understanding and support of all relevant stakeholders about the positive impact of healthy and supportive work environment and have on the recruitment and retention of health professionals, patient outcomes and the health sector as a whole [29].

Table 6. Common Issues and Challenges Faced by the Millennial Nurses

The table 6 shows the common issues and challenges faced by millennial nurses. Findings revealed that three main themes, each of which was subsequently broken down into further subthemes. While some of the main themes had been anticipated through research, participants‘ narratives illustrate the above themes that reflect the common issues and challenges faced by the millennial nurses. Research has shown that nurse‘s trained can no longer meets the healthcare needs of the current century. The needs of the patient and health setting is becoming more complex and nurses need to achieve a higher level of skills, competencies and attitude to maintain quality, safety and effectiveness. Also, the nursing dearth increases the workload of nurses affecting the patient safety [30].

Table 7. Significant Differences on the evaluation of attitude and behavior of millennial nurses between themselves and their heads

 The results shows that the critical value is lower than the computed chi-square value, thus a not significant difference exist between the attitude and behavior as evaluated by nurses themselves and their heads. Millennial nurses are now factors that transform the personal, organizational and social factors. The healthcare environment, administration of care, safety and quality, patient experience and resource utilization has shifted from a linear to an exponential expansion of human knowledge process [30].

SUMMARY OF FINDINGS

This study explores the millennial nurses in the clinical practice in Riyadh hospitals. This also investigates the attitudes and behaviors of millennial nurses in the clinical practice towards self, work and professions including the factors affecting their clinical practice and the issues and challenges of the millennial nurses. The millennial nurses excels at multitasking and more engaged in workplace group [31], and seek bigger challenges and possibilities for advancement [32].

This study utilized explanatory mixed method research. The population comprised of millennial staff nurses working in Riyadh hospitals. Two hundred nurses were sampled from Riyadh hospitals in Riyadh City, Saudi Arabia. Self- constructed questionnaire and semi-structure questions were used to collect data for the study. The narratives gathered from the semi-structured questions were analyzed using the Braun and Clarkes Thematic analysis. The data collected from the questionnaire were analyzed using the descriptive and inferential statistics such as frequency, weighted arithmetic mean while the hypothesis was tested using Pearson‘s chi-square statistics at 0.05 level of significance. The results showed that the on the attitude toward self, the millennial nurses value the privacy with the personal, colleague, and patient information. Privacy addresses the question of who has access to personal information and under what conditions. Privacy is concerned with the collection, storage, and use of personal information, and examines whether data can be collected in the first place, as well as the justifications, if any, under which data collected for one purpose can be used for another (secondary) purpose [33].

In the areas of work, nurses want job security e.g., regular tenure in the nursing workplace. This entails that millennial nurses sees job security as a criteria in staying for a job. Discovering of determinants of job satisfaction is also a blossoming area of research. Attitude towards the profession, the millennial nurses believe in the power of education for professional growth. The behavior of millennial nurses towards self strongly agreed on keeping self-adheres to the standards of the profession for self- development and versatile electronic communicator who enjoy combine web-based social networking, messaging and texting while working in clinical setting. Towards their work, they develop a plan of care from what they synthesize. Behavior towards profession reveals that millennial nurses have an opportunity to learn from mistakes made without patient consequences, therefore building both the knowledge and confidence of new nurses in the profession. Millennial nurses are inquisitive by nature, and they frequently use technology to gather further knowledge. A quickly evolving world strengthens the nursing profession; it is necessary to highlight innovation and professional training [34].

On the factors affecting the clinical practice, orientation and training; supervision; organizational climate; nurse conflict were affecting their clinical practice. Most of the nurses believe that compensation benefits are the main factors affecting them as well as adequacy of staffing and leadership. On the common issues and challenges, the millennial nurses found to have increased nursing workloads, essential support mechanism and perceived risk.

CONCLUSION

The attitude of millennial nurses valued privacy within personal, colleague and patient information. They want job security and believe in the power of education for professional growth. The behavior of millennial nurses focus on developing plan of care for what they synthesize, have the opportunity to learn from mistakes made without patient consequences and keeping adhere to the standards of profession for self-development. In addition, the orientation and training is the main factor affecting their clinical practice. Finally, thematic analysis found major themes reflecting the issues and challenges of millennial nurses which are: nursing workload, essential support mechanism, perceived risk.

RECOMMENDATIONS

Based on the findings, the following recommendations were made:

• The characteristics of the millennial generation should be considered in job
• A multigenerational workforce program should be developed to distinguish the strategies
• Conducting a study focusing on all generation of nurses to understand all of their attitudes and behavior
• The job satisfaction of millennial nurses should be determined to understand the factors affecting their

REFERENCES

1. Pew Research Center (2015, September 3). The Whys and Hows of Generations Retrieved November 17, 2022 from https://www.pewresearch.org/ politics/2015/09/03the-whys-and-hows-of-generations- research/
2. Mediaford ( 23, August 2017). As America‘s largest demographic grows up, millennials begin pivot to suburbs, kids and big Retrieved November 18, 2022 from https://media.ford.com/ content/ fordmedia/ fna/us/en/news/2017/08/23/millennials-begin-pivot-to- suvs.html
3. Espinoza, , Ukleja, M., & Rusch, C. (2010).Managing the millennials: Discover the core competencies for managing today‘s workforce. Hoboken, N.J.: John Wiley & Sons. [4a] Loudenback, T. (2016). Millennials are rapidly changing today‘s business landscape—here are 6 reasons for it. Business Insider,1. Retrieved November 18, 2022 from http://www.businessinsider.com/jason- haber-millennials-best-socialentrepreneurs-2016-4.[4b] Pew Research Center (2015). Millennials generation next, confident, connected and open to change. Maryland: National Center for Health Statistics.
4. Bohl, (30, August 2019). The Saudi Monarchy Catches Up With Its Millennials. Retrieved November 22, 2022 from https://worldview.stratfor.com/article/saudi-monarchy-catches-its-millennials-generational- shifts-culture-religion-nationalism.
5. Howe and Strauss (2003) Howe, , & Strauss, W. (2003) Millennials go to college. American Association of Collegiate Registrars, 1-4
6. Adkins, (12, May 2016) Millennials: The Job- Hopping Generation Retrieved November 19 2022 from https://news.gallup.com/businessjournal/191459/millenn ials-job-hopping-generation.aspx
7. Taylor, P. (2014). The next America. New York, NY:
8. Waldrop, S., & Grawich, M. J. (2011, February). Millennials–Who are they, really? (Organizational Health Initiative). St. Louis, MO: Organizational Health Initiative.
9. Fleming, (2015). Millennials and the media. Editor & Publisher,1. Retrieved November 20, 2022 from http://www.editorandpublisher.com/feature/millennials- and-themedia/
10. Taylor, P., & Keeter, S. (2010). Millennials: Confident. open to change. Pew Research Center. Retrieved November 16,  2022 from http://www.pewsocialtrends.org/ files/2010/10/millennials-confidentconnected-open-to- change.pdf.
11. Cook, (2014). How millennials will change the world of work. Nationaljournal.com. Retrieved November 16, 2022 from http://www.theatlantic.com/business/archive /2014/05/ how-millennials-willchange-the-world-of-work/425898/
12. Moore, , Gurnberg, L., & Krause, A. J. (2015). Generational differences in workplace expectations: A comparison of production and professional workers. Current Psychology, 34(20), 346-362. doi:10.1007/s 12144-014- 9261-2
13. Calvin (2015). Physicians workforce: legal immigrants will extend baby boom Retrived from https://www.science.gov/topicpages/b/baby+boom+popu lation
14. Toothaker R &      tallafero           (2017).      A phenomenological study of millennial students and traditional pedagogies. Retrieved November 20, 2022 from https://cfrps.unistra.fr/fileadmin/uploads/websites/cfrps/Analyse_d_articles/article_delacour.pdfhttp://dx.doi.org/ 10.1016/j.profnurs.2017.01.004 8
15. Benner, , Stephen, M., Leonard, V., & Day, V. (2010). Educating nurses: A Call for radical transformation. San Francisco: CA: Jossey-Bass.16.
16. Cahill, and Sedrak, M. (2012) Leading a Multigenerational Workforce: Strategies for Attracting and Retaining Millennials. Frontiers of Health Services Management, 29, 3-15.
17. Neal, S. and Wellins, R. ( 11, April 2018). Generation X — not millennials — is changing the nature of work. Retrieved November 17, 2022 from https://www.cnbc. com/2018/04/11/generation-x–not-millennials–is-chang ing-the-nature-of-work.html
18. Sujansky, G.(2014). Motivate your millennial employees. SuperVision 71.4, 13-15.
19. Watson, J., Macdonald, G., Brown, D. (2013) Clinical supervision for novice millennial nurses in the perinatal setting: The need for generational sensitivity Open Journal of Nursing, 2013, 3, 373-378. http://dx.doi.org/10.4236/ojn.2013.35050
20. Venter, E. (2017). Bridging the communication gap between Generation Y andthe Baby Boomer generation, International Journal of Adolescence and Youth, 22:4, 497-507, DOI:10.1080/02673843.2016.1267022.
21. PrenskyM (2011 Digital Natives, Digital Immigrants On the Horizon (MCB University Press, 9 No. 5
22. Bene (2021). Challenge the future of work. Retrieved November 22, 2022 from https://bene.com/en/office- magazine/challenge-the-future-of-work-report/
23. McGovern, (13, March 2017). Millennial attitude. Retrieved November 21, 2022 from https://medium.com/@gerrymcgovern/millennial- attitude-846fec2a4aba.
24. Stewart, Jeanine & Oliver, Elizabeth & Cravens, Karen & Oishi, (2016). Managing millennials: Embracing generational differences. Business Horizons. 60. 10.1016/j.bushor.2016.08.011.
25. Riegel, (2013). Orienting a new generation of nurses: Expectations of the millennial new graduate Open Journal of Nursing, 2013, 3, 461-466 . http://dx.doi.org/10.4236/ ojn.2013.37062
26. McQueen, , Cockroft, M., Mullins, N. (2017). Imogene King’s Theory of Goal Attainment and the Millennial Nurse: An Important Mentoring Tool for Nurse Educators, Teaching and Learning in Nursing,Volume 12, Issue 3, 223-225. https://doi.org/ 10.1016/j.teln.2017.03.003.
27. Cabalsa, O. (2018). The Entry-Level Nursing Competencies And The Gaps Between Nursing Education And Practice. International Journal of Advanced Research and Publications.
28. International Council of Nurse (2007). Positive practice environments: quality workplaces = quality patient care. Information and Action Tool Kit developed by Andrea Baumann for Geneva: International Council of Nurses http://www.icn.ch/indkit2007.pdf
29. Sese, (2022). Supervision of the Emerging Millennial Nurses as Experienced by Nurse Administrators. Journal of Positive School Psychology http://journalppw.com 2022, Vol. 6, No. 6, 142 – 153.
30. Keepnews, D. M., Brewer, C. S., Kovner, C. T., & Shin, H. (2010). Generational differences among newly licensed registered nurses. Nursing Outlook, 2(3)155-163. doi:10.1016j.outlook.2009.11.001
31. Walsh, D. (2015). Millennials in the workplace; for employers, words to the wise from the Y’s. Crain’s Detroit Business, 30(13), 11-16.
32. Institute of Medicine (US) Committee on Regional Health Data Networks; Donaldson MS, Lohr KN, Health Data in the Information Age: Use, Disclosure, and Privacy. Washington (DC): National Academies Press (US); 1994. 4, Confidentiality and Privacy of Personal Data. Available from: https://www.ncbi.nlm.nih.gov/books/NBK236546/
33. Kara Yılmaz, . (2015). Innovation in Nursing Practices. Global Journal on Advances in Pure & Applied Science, 2. 170-174.