Generational Diversity-The Nexters

Perioperative accountable care teams: Improving surgical team efficiency and work satisfaction through interprofessional collaboration

The purpose of this performance improvement project was to design, implement and evaluate an interprofessional education initiative intended to improve surgical team efficiency, communication and work satisfaction. The development of interprofessional perioperative accountable care teams in three surgical specialties, cardiothoracic, neurosurgery and orthopedics, demonstrated a reduction in turnover time, increased staff, patient and surgeon satisfaction, and increased operating room (OR) revenue generated by the surgical specialties within one year of implementation.

Catering to millennial learners: assessing and improving fine-needle aspiration performance

OBJECTIVES

Fine-needle aspiration (FNA) of a palpable cervical lymph node is a straightforward procedure that should be safely performed by educated general surgery (GS) trainees. Retention of technical skill is suspect, unless sequential learning experiences are provided. However, voluntary learning experiences are no guarantee that trainees will actually use the resource.

DESIGN

A 3-minute objective structured assessment of technical skill-type station was created to assess GS trainee performance using FNA. Objective criteria were developed and a checklist was generated (perfect score = 24). Following abysmal performance of 11 postgraduate year (PGY)-4 trainees on the FNA station of our semiannual surgical skills assessment ("X-Games"), we provided all GS residents with electronic access to a 90-second YouTube video clip demonstrating proper FNA technique. PGY-2 (n = 11) and PGY-3 (n = 10) residents subsequently were tested on FNA technique 5 and 12 days later, respectively.

RESULTS

All 32 trainees completed the station in less than 3 minutes. Overall scores ranged from 4 to 24 (mean = 14.9). PGY-4 residents assessed before the creation of the video clip scored lowest (range: 4-18, mean = 11.4). PGY-3 residents (range: 10-22, mean = 17.8) and PGY-2 residents (range: 10-24, mean = 15.8) subsequently scored higher (p < 0.05). Ten residents admitted watching the 90-second FNA video clip and scored higher (mean = 21.7) than the 11 residents that admitted they did not watch the clip (mean = 13.1, p < 0.001). Of the 11 trainees who did not watch the video, 6 claimed they did not have time, and 5 felt it would not be useful to them.

CONCLUSIONS

Overall performance of FNA was poor in 32 midlevel GS residents. However, a 90-second video clip demonstrating proper FNA technique viewed less than 2 weeks before the examination significantly elevated scores. Half of trainees given the chance to learn online did not take the opportunity to view the video clip. Although preemptive learning is effective, future efforts should attempt to improve self-directed learning habits of trainees and evaluate actual long-term skill retention.

The perception of radiation therapy students on a clinical specialist radiation therapist-led breast workshop

Purpose

The clinical specialist radiation therapist (CSRT) is a radiation therapist with advanced site-specific clinical skills and knowledge that can be utilised to enhance the education of radiation therapy (RT) students within an academic setting. The aim of this study is to assess the students’ perception of the teaching provided by a CSRT within a case-based learning workshop tailored for breast cancer.

Methods

A workshop that followed the patient's RT treatment pathway (consultation, CT simulation, treatment planning and delivery) was led by a breast-site CSRT to 16 third-year students. Following completion of the workshop, a 4-point Likert-scale survey was distributed to explore the students’ didactic and clinical experiences and their general perceptions of the CSRT's contribution to their breast-site module education.

Results

The median didactic experience reported by the students were ‘a lot’ in patient care and ‘some’ in treatment unit and treatment planning. In contrast, the students reported less clinical experience; the median response for patient care and treatment unit experience was ‘a little’ and ‘none’ for treatment planning. All 13 students who responded to the survey agreed that the CSRT enhanced their understanding of the material. The students felt engaged in the CSRT-lecture and perceived it as value added. The majority of the students (92%) indicated the CSRT to be a useful learning resource in their training and education. Additional comments provided by the students noted the utility of the CSRT-led lecture in consolidating their knowledge of the breast cancer treatment planning and delivery and suggest further expansion of this learning format to other disease sites.

Conclusions

Third-year RT students commencing their clinical practicum will have had a greater proportion of their learning from didactic teaching as opposed to clinical experience. In transitioning to their final year, the focus of the curriculum shifts to the application of theory into the clinical environment. The students perceived the CSRT to be a useful resource to enhance their understanding of the breast-site module and their feedback supports the instructional quality and effectiveness of the CSRT in this clinical teaching role.

Career flexibility and family-friendly policies: an NIH-funded study to enhance women's careers in biomedical sciences

BACKGROUND

Although women receive nearly half of all doctoral degrees and show a high interest in academic careers, the pipeline is leaky. The challenge of balancing life course events with career trajectory is an important determinant leading to premature dropout or slower career advancement. This report describes the findings of the first phase of a National Institute of Health Office of Research on Women's Health (NIH ORWH)-funded study using survey and academic data for exploring satisfaction and awareness of/intent to use specific career flexibility options at the University of California, Davis (UCD).

METHODS

All men and women faculty in the UCD's Schools of Medicine (SOM) and Veterinary Medicine (SVM) and College of Biological Science (CBS) were surveyed. Data also were obtained from deans' offices on use of family-friendly benefits by faculty.

RESULTS

Three hundred twenty-five total survey responses were received from the SOM, 83 from SVM, and 64 from CBS, representing 42%, 46%, and 52% of their total faculty, respectively. In each school, large percentages of men (32%-60%) and women (46%-53%) faculty have children under 18 and a moderately high level of demand of family care responsibilities. Women were significantly more likely to be childless, particularly in the SOM (35% vs. 14%, p<0.001). For all schools, documented use of any family-friendly policy was low (0%-11.5%), as was awareness of policies, although both were significantly higher for women than for men. Significantly more women than men wanted to use policies or chose not to, particularly in the SOM (51% vs. 28%, p<0.001, and 37% vs. 23%, p=0.016, respectively), because of multiple barriers. Faculty in all schools agreed/highly agreed that policies were important to recruitment, retention, and career advancement.

CONCLUSIONS

Family-friendly policies are pertinent to men and women, as both demonstrate interest and need, linked to increased career satisfaction. A family-friendly policy is important, particularly for women in the biomedical sciences.

Contrasting burnout, turnover intention, control, value congruence and knowledge sharing between Baby Boomers and Generation X

AIM(S)

This paper examines the contrasting role of work values for nurses from two generations: Baby Boomers and Generation X.

BACKGROUND

Differences among nurses regarding core values pertaining to their work has a potential to influence the quality of their work life. These differences may have implications for their vulnerability to job burnout.

EVALUATION

The analysis is based upon questionnaire surveys of nurses representing Generation X (n = 255) and Baby Boomers (n = 193) that contrasted their responses on job burnout, areas of work life, knowledge transfer and intention to quit.

KEY ISSUE(S)

The analysis identified a greater person/organization value mismatch for Generation X nurses than for Baby Boomer nurses. Their greater value mismatch was associated with a greater susceptibility to burnout and a stronger intention to quit for Generation X nurses.

CONCLUSION(S)

The article notes the influence of Baby Boomer nurses in the structure of work and the application of new knowledge in health care work settings. Implications for recruitment and retention are discussed with a focus on knowledge transfer activities associated with distinct learning styles.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding value differences between generations will help nursing managers to develop more responsive work settings for nurses of all ages.

Intergenerational views of hardiness in critical care nurses

As all nurses are aware, healthcare is experiencing a time of great change. This change can lead to stress, nurse vacancy rates, and burnout. However, the effects of stress can be mitigated by personal hardiness. This article presents an overview of hardiness, as well as the results of a qualitative study to describe hardiness in the workplace.

Generational forecasting in academic medicine: a unique method of planning for success in the next two decades

Multigenerational teams are essential to the missions of academic health centers (AHCs). Generational forecasting using Strauss and Howe's predictive model, "the generational diagonal," can be useful for anticipating and addressing issues so that each generation is effective. Forecasts are based on the observation that cyclical historical events are experienced by all generations, but the response of each generation differs according to its phase of life and previous defining experiences. This article relates Strauss and Howe's generational forecasts to AHCs. Predicted issues such as work-life balance, indebtedness, and succession planning have existed previously, but they now have different causes or consequences because of the unique experiences and life stages of current generations. Efforts to address these issues at the authors' AHC include a work-life balance workgroup, expanded leave, and intramural grants.

Journeying through clinical placements--an examination of six student cases

INTRODUCTION

How student nurses are permitted to participate in healthcare settings during placements is central to their skill development, formation of occupational identity and retention in nursing. Novices' participation and learning was mapped through their clinical experiences from student to graduate, as part of a multi-method longitudinal study examining nurses' workplace learning.

METHODS

Twenty-nine second and third year nursing students participated in a series of interviews over a two year period. Six students, representing a cross-section of a student cohort form the basis of this case study. Interviews were transcribed verbatim and thematically coded.

RESULTS

Four themes encapsulating the participants' journeys through clinical situations were identified; (a) creating learning opportunities, (b) gaining independence, (c) becoming part of the team and (d) generational differences. The themes reflect the development of novice nurses and the nuances of the workplace as a learning environment.

DISCUSSION

The cases highlight the importance of supportive placements that comprise openness with opportunities, tolerance of inter-generational differences and invitations to become part of the nursing team. The challenge for nurse educators is how to best prepare students for the complexities of the social, cultural and political arena of clinical practice.

Addressing the turnover issue among new nurses from a generational viewpoint

AIM

To investigate the relationship between dimensions of the psychosocial work environment and the intent to quit among a new generation of nurses.

BACKGROUND

As a new generation of nurses enters the workforce, we know little about their perception of their current work environment and its impact on their intent to stay.

METHOD

A self-administered questionnaire was distributed to 1002 nurses.

RESULTS

The nurses who intended to quit their positions perceived a significant effort/reward imbalance as well as a lack of social support. The nurses who intended to quit the profession perceived a significant effort/reward imbalance, high psychological demands and elevated job strain.

CONCLUSION

The balance between the level of effort expended and reward received plays an important role in young nurses' intent to leave.

IMPLICATIONS FOR NURSING MANAGERS

Nurse Managers must offer Nexters, from the beginning of their career, a meaningful work and supportive environment. Without the efforts of the organization to improve the work environment and support nurses, this generation may not feel valued and move to another organization that will support them or another career that will offer fulfilment.

Web-based instruction: getting faculty onboard

Although many colleges and universities have embraced distance education, a significant number still have not. Approximately 40% of faculty from these institutions have not accepted the value and legitimacy of online education [Allen, I. A., & Seaman, J. (2003). Sizing the opportunity: The quality and extent of online education in the United States, 2002, 2003. Needham, Mass: The Sloan Consortium]. One reason for this may be that faculty are not sufficiently informed about online learning and the role they might play in teaching in this environment. A number of salient issues are addressed: who our students are; what drives colleges and universities to offer distance education; which educational theory underpins distance education; how distance education fares in terms of quality as compared with face-to-face instruction; what the advantages and disadvantages of teaching online are; how teaching style is affected; and what types of support faculty need in providing instruction in this medium. Some recommendations are included for faculty who are considering teaching online. In this article, distance education refers to an asynchronous, web-based, and online format.

Generational (age) differences in nursing students' preferences for teaching methods

A generational age transformation is occurring in nursing classrooms across the United States. Nurse educators need to prepare for the different values and expectations of students from Generation X and the newly emerging Generation Y in the educational environment. This quantitative, descriptive research begins to examine the preferences and expectations of these generations regarding teaching methods.

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004

Background

Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships.

Methods

Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work.

Results

Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships.

Conclusion

In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted.

Multigenerational challenges in academic medicine: UCDavis's responses

Academic medicine is a unique work environment, one of the few where members of four different generations regularly interact and where multigenerational teams are key to fulfilling its missions, particularly education. This can lead to increased creativity, but also to intergenerational conflict, since each generation has different values and expectations. The authors describe multigenerational challenges confronted at the University of California, Davis, School of Medicine, and that school's responses to them. These challenges include issues related to work hours, workload, compensation, evaluation for advancement, recruitment and retention, and attendance at required meetings. Awareness of the different generational qualities and values allowed the school of medicine to identify the multigenerational origin of many of these ongoing issues and challenges and to plan appropriate solutions within the Office of Academic Affairs. These include policy changes related to work-life balance, utilizing multiple faculty tracks with different roles, allowing part-time faculty appointments, creating a variety of faculty development programs geared toward different generational needs (which utilize flexible modules, menus of options, and alternative technologies for presentation), defining appropriate reward and incentives through compensations plans, and creating peer-reviewed awards. The authors conclude that these efforts mitigate conflict, promote diversity, and allow multigenerational teams to function more effectively and creatively in education, research, and clinical care. Ongoing evaluation will further refine this approach.