Home > RNJ > 2007 > January/February > Editorial: Bridging the Generation Gap

Editorial: Bridging the Generation Gap
Elaine Tilka Miller, DNS RN CRRN FAHA FAAN Editor

Have you ever interacted with either a nurse or patient from another generation and immediately recognized that there is a major disconnect? Perhaps you can remember a specific situation that did not go well with a younger nurse and older patient regarding post-operative education. Or, you may recall a heated discussion between an older nurse and new graduate on how to correctly perform a dressing change or organize care for an upcoming shift? In some instances, the outcomes may be positive, but often you only feel additional stress in an already demanding patient care situation. Moreover, you may have experienced a sense of discomfort and frustration caused by the lack of understanding and compassion between generational views. It is also well documented that conflicts and tensions arising from nurses of different generations dramatically affect nurse recruitment, retention, education, and management (Sherman, 2006).

How can we overcome this cycle of generational conflict? An initial step is helping individuals look beyond their own perspectives to appreciate the historical events, conditions, values, and behaviors that make each generation unique. For instance, the events of 9/11 had a tremendous influence affecting many U.S. citizens’ sense of security and the realization that we now live in a mobile and dangerous global community. In addition, recent circumstances such as contamination of food supplies with E. coli, spread of contagious diseases, and oil shortages shape how we view our world and our behaviors. These changes occurring around us, particularly as we age, cause feelings of uncertainty and a greater awareness that the world we grew up in is not the world we live in today.

Generational Categories

How should we classify the generational differences? Lancaster and Stillman (2002), well-known experts, differentiate the generations in the following manner:

Traditionalists (Born between 1900–1945)—about 75 million people—grew up during two World Wars and the Depression, they are savers, do not waste, are hard working, God fearing, patriotic, loyal, and desire to build a legacy.

Baby Boomers (Born between 1946–1964)—approximately 80 million people—grew up with the development of such things as super markets, television, the Vietnam War, Watergate, sit-ins, the Beatles, and are generally labeled as optimistic, idealistic, competitive, motivated to build a stellar career, the “Me” generation, but are also presently in positions of power in many of today’s businesses and politics.

Generation Xers (Born between 1965–1980)—approximately 40 million people—skeptics, resourceful, independent, believe in a portable career, and experienced childhoods that were revolutionized by technology such as video games, fax machines, microwave ovens, cellular phones, and personal computers, but they also grew up at a time when more violence appeared in news, and sexual permissiveness was more accepted. AIDS was more common in their neighborhoods.

Millennial Generation (Born between 1981–1999)—around 76 million people—more global in perspective, realistic about the challenges of modern life and technology, collaborative, practical, and tend to develop parallel careers (true multitaskers who can simultaneously learn and perform several careers well).

Futuristic Generation (Born in 2000 and after)—presently undefined characteristics—will be similarly affected by the apparent shrinking of the world due to almost instantaneous communication, additional technological advancements, world conflicts, an expanding world population (an anticipated jump from 5.5 billion to 11 billion), and limited resources to accommodate this increased demand.(see http://libray.thinkquest.org/23440/futuristic.html).

Impact on Rehabilitation Nursing

As rehabilitation nurses, we must first acknowledge these generational differences, just as we recognize differences in race, gender, and ethnicity. Second, we need to further develop an understanding of how generational experiences and values influence attitudes and behaviors. For instance, Generation Xers, who are very resourceful and independent, may not respond well to the optimistic attitude of the Baby Boomers as they attempt to adjust their lives and career goals as a result of their illness, accidents or other personal injuries. Third, all rehabilitation nurses must cultivate an accepting spirit and realize that old behaviors and attitudes regarding individuals of varied generations are difficult to change. In addition, we must be open to interventions that promote greater supportive communication, accept variability in how outcomes are achieved, and encourage teamwork that respects and values diversity in thought and approach.

Although it is sometimes difficult to change old habits and styles of interaction with patients and nurses, such change must happen if we are to appreciate the attitudes and behaviors of others. We must change the cycle of generational conflict that permeates nursing and patient care at all levels and create a work environment and resultant patient care setting that values, respects, and positively responds to generational differences.

In a study involving Generation X and Millennial nurses, Wieck, Prydum, and Wlash (2002) discovered that the attributes of honesty, positive attitude, approachable manner, and good communication skills, along with being knowledgeable and supportive, were of highest importance when describing nurse leaders. Meanwhile, Chao (2005) reported flexibility in work was most important to nurses 40 and younger, while older nurses in the Baby Boomer generation ranked meaningful work most significant. These differences in the majority of our present nursing workforce indicate that as colleagues and leaders, we must value each other’s individual priorities and motivators. Plus, the same appreciation and respect of nurses from varied generations should be applied to our patients.

Many strategies can be initiated to bridge the generation gap and reduce the resultant conflicts and stress. For instance, consider the following.

Communicate and Listen

Within each generation there are specific differences in life expectancy, language usage (i.e., colloquialisms), prominent figures in history, entertainment preferences, lifestyle patterns (i.e., family composition, general daily activity routines, diet, etc.), and advances in science and technology. As a rehabilitation nurse listens to patients, families, and colleagues, an attempt should be made to discern communication preferences, salient life experiences, and expectations.

For instance, older adults from the Traditionalist generation prefer face-to-face contact and respond well to careful listening and perception checks that acknowledge comprehension of what has been said. Yet, patients and nurses of the Millennium generation may prefer e-mail and immediate daily feedback regarding their progress rather than monthly face-to-face communication as with older patients. In addition, older patients expect a more formal communication style, while other generations may prefer an informal style that permits use of first names.

Another strategy that may facilitate communication is identifying common life experiences among the different generations. Most of us remember, for example, when we first drove a car, rode a bicycle, had our first date, can name our favorite dish, or describe a preferred leisure activity. Although just a sampling of potential topics, these may stimulate conversation and establish greater rapport with a patient or colleague.

Educational Programs

Educational programs should expand the knowledge of generational differences. Yet, it is critical to recognize that generations respond to varied teaching approaches. For instance, Baby Boomers tend to enjoy life long learning, collegiality, and participation with a preference for peer situations, while Millenniums want more structure, guidance, extensive orientations, and personal feedback (Duchscher & Cowin, 2004; Halfer, 2005).

With regard to conflicts, the major differences between generations pertain to work ethics (home and job) and the use of technology. Both Generation X and Millennium nurses/patients want work-life balance and gravitate to technology, while Baby Boomers and Traditionalists are more inclined to accept schedule changes to accommodate others and be more resistant to use of newer technology (Weston, 2001).

Mentorship Programs

Much can be learned when two people from different generations are paired.

For instance, a younger nurse may be more technologically competent with computers, programming machines of patient monitoring devices, or text messaging, while an older nurse may be more experienced with the subtleties of organ rejection or neurogenic shock or on how to care for a dying patient. Mentoring programs, if part of an organization’s culture, permit patients to assist others in dealing with the loss of a limb, facial and hair changes associated with a burn, or alterations in mobility associated with severe arthritis. Of course, the criteria to determine this matching is pivotal, but it is an excellent vehicle to create bonds of understanding, trust, learning, confidence, and valuing the differences between generations. Moreover, older generations (Traditionalists and Baby Boomers who possess valuable knowledge and skills, but feel margionalized in today’s society) may have a renewed purpose and energy when participating in the mentoring process.


Generational differences will always exist among nurses and patients. However, with our limited resources, the aging of our patient population, and increased longevity, it is pivotal that we identify effective strategies to transcend generational differences that may compromise patient care. By joining forces, we can maximize our knowledge and skills and in the process enhance our ability to value the contribution of these generational differences to improve quality nursing care and rehabilitation practice. Although the solutions may not be simple, we must persist in discovering creative solutions to overcome the multiple conflicts emerging from patient and nursing generational differences.


Chao, L. (November 29, 2005). What GenXers need to be happy at work. The Wall Street Journal, B6.

Duchscher, J. E., & Cowin, L. (2004). Multigenerational nurses in the workplace. Journal of Nursing Administration, 34(11), 493-501.

Halfer, D. (March 14, 2005). What nurses want: Different generations, different expectations. Hospitals and Health Networks. Retrieved 10/31/2006 from www.hhnmag.com/hhnmag/hospitalconnect/search/jsp? Dcrpath=HHNMAG/PubsNewsArticle/data/0503HHN-FEA_CoverStory&domain=HHNMAG

Lancaster, L, & Stillman, D. (2002). When generations collide. New York: Harper Business.

Sherman, R. O. (2006). Leading a multigenerational nursing workforce: Issues, challenges, and strategies. The Online Journal of Issues in Nursing, 11, 2, 1-10

Weston, M. (2001). Coaching generations in the workplace. Nursing Administration Quarterly, 25 (2), 11-21.

Wieck, K. L., Prydum, M., & Wlash, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34 (3), 283-288. Generation Gap – Futuristic Generation. Retrieved 11/12/200 (http://libray.thinkquest.org/23440/futuristic.html